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HAS-BLED score
Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
🧮 HAS-BLED estimates 1-year major bleeding risk in patients with atrial fibrillation (AF) on oral anticoagulation. ⚖️ It is designed to highlight modifiable bleeding risks, not to deny anticoagulation when stroke risk is high. 🩺 Always interpret alongside CHA₂DS₂-VASc.
🧾 HAS-BLED Criteria (1 point each unless stated)
| Criterion | Definition | Score |
|---|---|---|
| H – Hypertension 💓 | Systolic BP >160 mmHg (uncontrolled) | +1 |
| A – Abnormal Renal Function 🧪 | Dialysis, renal transplant, or creatinine >200 μmol/L | +1 |
| A – Abnormal Liver Function 🧬 | Cirrhosis or bilirubin >2× ULN with AST/ALT/ALP >3× ULN | +1 |
| S – Stroke History 🧠 | Previous ischaemic or haemorrhagic stroke | +1 |
| B – Bleeding History 🩸 | Prior major bleed or predisposition (e.g., anaemia) | +1 |
| L – Labile INR 📉 | Time in therapeutic range (TTR) <60% (warfarin only) | +1 |
| E – Elderly 👴 | Age >65 years | +1 |
| D – Drugs 💊 | Antiplatelets or NSAIDs | +1 |
| D – Alcohol 🍷 | >8 units/week (or excess intake) | +1 |
| 👉 Maximum Possible Score = 9 | ||
📊 Interpretation
- 0–1: Low bleeding risk.
- 2: Moderate risk – address modifiable factors.
- ≥3: High risk – requires caution, regular review, and optimisation of reversible risks.
A higher HAS-BLED score correlates with increased annual major bleeding rates. In original validation cohorts, bleeding risk rose progressively with scores ≥3.
⚖️ Practical Clinical Use
- 🔎 Identify reversible risks:
- Control blood pressure.
- Stop unnecessary NSAIDs or dual antiplatelets.
- Optimise renal function where possible.
- Reduce alcohol intake.
- 🧪 For warfarin patients, improve time in therapeutic range.
- 🛡️ Consider gastroprotection (PPI) if GI bleeding risk.
- 📅 Arrange closer follow-up if score ≥3.
🧠 Key Teaching Points
- HAS-BLED does not replace stroke risk assessment.
- A high score should prompt optimisation, not automatic withdrawal of anticoagulation.
- In most AF patients, stroke risk outweighs bleeding risk.
- Particularly useful in shared decision-making discussions.
📖 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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