HAS-BLED Score

The HAS-BLED score is designed to assess the 1-year risk of major bleeding in patients with atrial fibrillation and therapeutic anticoagulation. Major bleeding is characterized as follows: intracranial hemorrhage, need for hospitalization, relevant hemoglobin drop, need for transfusion.
For risk stratification of ischemic stroke and thromboembolism in patients with atrial fibrillation, the CHA2DS2-VASc score can be used.

Hypertension
Abnormal renal function
Dialysis, kidney transplantation, creatinine ≥ 200 µmol/l (≥ 2.26 mg/dl)
Abnormal liver function
Liver disease, bilirubin > 2× ULN with ASAT/ALAT/AP > 3× ULN
Stroke history
Previous major Bleeding or predisposition to bleeding
Labile INR
Age > 65 years
Medications predisposing to bleeding
Antiplatelet agents, NSAID
Alcohol
≥ 8 units/week

HAS-BLED Score:

  • bleedings per 100 patient-years
  • Risk for major bleeding:

Recommendation:

ULN = upper limit of normal, ASAT = aspartate transaminase, ALAT = alanine transaminase, AP = alkaline phosphatase, INR = international normalized ratio, NSAID = non-steroidal anti-inflammatory drugs

Interpretation
Points Bleedings per 100 patient-years [1] Risk for major bleeding [3] Recommendation
0 1.13 0.9 %

Low risk for major bleeding

Anticoagulation should be considered
1 1.02 3.4 %

Moderate risk for major bleeding

Anticoagulation may be considered
2 1.88 4.1 %
3 3.74 5.8 %

High risk of major bleeding

Caution with anticoagulation. Alternatives should be considered.
4 8.7 8.9 %
5 12.5 9.1 %
> 5 - - Very high risk of major bleeding
References
  1. Pisters R, Lane DA, Nieuwlaat R 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: 1093-1100
  2. Hindricks G, Potpara T, Dagres N et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020:
  3. Lip GY, Frison L, Halperin JL et al. 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; 57: 173-180

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