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A Practical Guide to Haemostasis


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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