Bedside Rounds

HAS-BLED bleeding risk score

HAS-BLED estimates the one-year risk of major bleeding in patients with atrial fibrillation on anticoagulation. Its main use is to find and fix modifiable bleeding risks.

What goes into the HAS-BLED

  • Uncontrolled hypertension (SBP > 160) (+1)
  • Abnormal renal function (dialysis, transplant, Cr > 2.26 mg/dL) (+1)
  • Abnormal liver function (cirrhosis, bilirubin > 2× or AST/ALT > 3× ULN) (+1)
  • Prior stroke (+1)
  • Prior major bleeding or predisposition (+1)
  • Labile INR (on warfarin) (+1)
  • Elderly (> 65) (+1)
  • Antiplatelet or NSAID use (+1)
  • Alcohol ≥ 8 drinks/week (+1)

How to interpret the result

  • 0–2: low to moderate bleeding risk
  • ≥ 3: high bleeding risk; address modifiable factors and review more often

Clinical pearls

  • A high score alone is not a reason to withhold anticoagulation; stroke risk usually outweighs bleeding risk.
  • Modifiable items: uncontrolled blood pressure, labile INR, antiplatelet or NSAID use, and alcohol.

Evidence

  1. Pisters R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation. Chest. 2010;138:1093-1100.

Related workups

Atrial fibrillation with rapid ventricular responseMajor bleeding on anticoagulants (reversal)Pulmonary embolismDeep vein thrombosis

Related calculators

CHA₂DS₂-VAScCreatinine clearance (Cockcroft-Gault)All calculators

For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.