HAS-BLED Score

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Assessing the Risk of Bleeding in Patients with non-valvular Atrial Fibrillation [AF]:
The HAS-BLED Score

Introduction:

The HAS-BLED Score is a clinical prediction rule for estimating the risk of major bleeding in patients with non-valvular Atrial Fibrillation [AF] on Warfarin.

The HAS-BLED Score:

Select Criteria:

[H] Hypertension Uncontrolled BP >160 mmHg systolic
	1 Point
[A] Abnormal renal function: - On Dialysis, Renal transplant, - Cr >2.6 mg/dL or >200 μmol/L Abnormal liver function - Cirrhosis or Bilirubin >2x Normal - or AST/ALT/AP >3x Normal
	1 Point - for abnormal renal function
	1 Point - for abnormal liver function
[S] Stroke: Prior history of stroke
	1 Point
[B] Bleeding: Prior Major Bleeding or Predisposition to Bleeding Anaemia
	1 Point
[L] Labile INR: (Unstable/high INRs) Time in Therapeutic Range < 60%
	1 Point
[E] Elderly: Age ≥ 65 years
	1 Point
[D] Prior Alcohol or Drug Usage History Medication Usage Predisposing to Bleeding (Antiplatelet agents [excluding Clopidogrel], NSAIDs)
	1 Point - for drug usage
	1 Point - for alcohol

Score

Maximum Score 9 points

Interpretation
Total No. of Points	Annual Risk of Major Bleeds [%]	Bleed Risk Category
0	1.13	Low
1	1.02	Low
2	1.88	Intermediate
3	3.74	High
4	8.70	High
5	12.5	High

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Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

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1. The HAS-BLED score has been evaluated in predicting the risk of bleeding events in patients with VTED receiving anticoagulation and shown to have a high positive predictive value.

LINKS & References

1. Pisters R, Lane DA, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138: 1093-100.

2. Apostolakis S, Lane DA, et al. Comparison of the CHADS2, CHA2DS2-VASc and HAS-BLED scores for the prediction of clinically relevant bleeding in anticoagulated patients with atrial fibrillation: the AMADEUS trial. Thromb Haemost. 2013; 110: 1074-9.

3. Yoshida R, Ishii H, et al. Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention. Journal of Cardiology. 2018.

4. Proietti M, Rivera-Caravaca JM, et al. Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS-BLED and GARFIELD-AF Bleeding Scores. J Am Heart Assoc. 2018; 7: e009766.

5. Chao TF, Lip GYH, et al. Incident Risk Factors and Major Bleeding in Patients with Atrial Fibrillation Treated with Oral Anticoagulants: A Comparison of Baseline, Follow-up and Delta HAS-BLED Scores with an Approach Focused on Modifiable Bleeding Risk Factors. Thromb Haemost. 2018; 118: 768-77.

6. Lip GY, Lin HJ, et al. Comparative assessment of the HAS-BLED score with other published bleeding risk scoring schemes, for intracranial haemorrhage risk in a non-atrial fibrillation population: The Chin-Shan Community Cohort Study. International Journal of Cardiology. 2013.

7. Brown JD, Goodin AJ, et al. Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism: Application of the HAS-BLED Bleeding Score During the First 6 Months of Anticoagulant Treatment. J Am Heart Assoc. 2018; 7.

8. Borre ED, Goode A, et al. Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review. Thromb Haemost. 2018; 118: 2171-87.

9. Chao TF, Lip GYH, et al. Incident Risk Factors and Major Bleeding in Patients with Atrial Fibrillation Treated with Oral Anticoagulants: A Comparison of Baseline, Follow-up and Delta HAS-BLED Scores with an Approach Focused on Modifiable Bleeding Risk Factors. Thromb Haemost. 2018; 118: 768-77.

10. Click HERE to access the NICE guidelines on Atrial Fibrillation.

11. Lip GYH, Banerjee A, et al. Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. Chest. 2018; 154: 1121-201.

13. Click HERE to access the ACCP guideline on Anithrombotic Therapy for Atrial Fibrillation.

14. Lip GYH, Skjoth F, et al. The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants. Am J Med. 2018; 131: 574 e13- e27.