HAS-BLED Score

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Clinical Use

Assess risk of bleeding from anticoagulation in patients with atrial fibrillation

More Info

The HAS-BLED score was derived from a cohort of 3978 in the Euro Heart Survey on AF. A bleeding risk score termed HAS-BLED is an acronym for Hypertension, Abnormal liver/renal function, Stroke history, Bleeding predisposition, Labile INR, Elderly, Drug/alcohol usage.

 

HAS-BLED Scoring
Risk FactorPoints
Hypertension+1
Renal disease (dialysis, transplant, Cr >2.26 mg/dL or 200 µmol/L)+1
Liver disease (cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal)+1
Stroke history+1
Prior major bleeding or predisposition to bleeding+1
Labile INR (unstable/high INRs, time in therapeutic range < 60%)+1
Elderly (age >65)+1
Medication usage predisposing to bleeding (aspirin, clopidogrel, NSAIDs)+1
Alcohol usage (≥ 8 drinks/week)+1

 

Risk of bleeding according to HAS-BLED Score
ScoreRiskRate of major bleeding at 90 days

0

Low

0.6-1.1%

1

Intermediate

1.0-1.5%

2

Intermediate

1.9-3.2%

3+

High

4.9-19.6%

References

1.Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey. Chest. 2010 Mar 18. Abstract
2.Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011 Jan 11;57(2):173-80. Abstract

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Developer: Sirikarn Napan, MD, FACC