{"id":28863,"date":"2022-06-22T10:05:42","date_gmt":"2022-06-22T08:05:42","guid":{"rendered":"https:\/\/www.inanutshell.ch\/?page_id=28863"},"modified":"2022-06-22T10:05:42","modified_gmt":"2022-06-22T08:05:42","slug":"has-bled-score","status":"publish","type":"page","link":"https:\/\/www.inanutshell.ch\/en\/digital-doctors-bag\/has-bled-score\/","title":{"rendered":"HAS-BLED Score"},"content":{"rendered":"<p>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.<br \/>\nFor risk stratification of ischemic stroke and thromboembolism in patients with atrial fibrillation, the <a href=\"https:\/\/hosttech.inanutshell.ch\/en\/digital-doctors-case\/cha2ds2-vasc-score\/\">CHA<sub>2<\/sub>DS<sub>2<\/sub>-VASc score<\/a> can be used.<\/p>\n    <div class=\"medical-calculator has-bled\" id=\"medical-calculator-has-bled\">\r\n        <form>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Hypertension\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"arterial-hypertonia\" id=\"medical-calculator-has-bled-arterial-hypertonia-n\" value=\"N\" tabindex=\"1\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"arterial-hypertonia\" id=\"medical-calculator-has-bled-arterial-hypertonia-y\" value=\"Y\" tabindex=\"2\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Abnormal renal function<br \/>\r\n                    <span class=\"label-lighter\">Dialysis, kidney transplantation, creatinine &ge; 200 \u00b5mol\/l (&ge; 2.26 mg\/dl)<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-3\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"abnormal-kidney\" id=\"medical-calculator-has-bled-abnormal-kidney-n\" value=\"N\" tabindex=\"3\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"abnormal-kidney\" id=\"medical-calculator-has-bled-abnormal-kidney-y\" value=\"Y\" tabindex=\"4\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Abnormal liver function<br \/>\r\n                    <span class=\"label-lighter\">Liver disease, bilirubin &gt; 2\u00d7 ULN with ASAT\/ALAT\/AP &gt; 3\u00d7 ULN<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-3\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"abnormal-liver\" id=\"medical-calculator-has-bled-abnormal-liver-n\" value=\"N\" tabindex=\"5\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"abnormal-liver\" id=\"medical-calculator-has-bled-abnormal-liver-y\" value=\"Y\" tabindex=\"6\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Stroke history\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"prev-strokes\" id=\"medical-calculator-has-bled-prev-strokes-n\" value=\"N\" tabindex=\"7\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"prev-strokes\" id=\"medical-calculator-has-bled-prev-strokes-y\" value=\"Y\" tabindex=\"8\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Previous major Bleeding or predisposition to bleeding\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"bleeding-tendency\" id=\"medical-calculator-has-bled-bleeding-tendency-n\" value=\"N\" tabindex=\"9\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"bleeding-tendency\" id=\"medical-calculator-has-bled-bleeding-tendency-y\" value=\"Y\" tabindex=\"10\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Labile INR\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"labile-inr\" id=\"medical-calculator-has-bled-labile-inr-n\" value=\"N\" tabindex=\"11\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"labile-inr\" id=\"medical-calculator-has-bled-labile-inr-y\" value=\"Y\" tabindex=\"12\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Age &gt; 65 years\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"age-lt-65y\" id=\"medical-calculator-has-bled-age-lt-65y-n\" value=\"N\" tabindex=\"13\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"age-lt-65y\" id=\"medical-calculator-has-bled-age-lt-65y-y\" value=\"Y\" tabindex=\"14\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Medications predisposing to bleeding<br \/>\r\n                    <span class=\"label-lighter\">Antiplatelet agents, NSAID<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-3\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"bleed-stim-meds\" id=\"medical-calculator-has-bled-bleed-stim-meds-n\" value=\"N\" tabindex=\"15\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"bleed-stim-meds\" id=\"medical-calculator-has-bled-bleed-stim-meds-y\" value=\"Y\" tabindex=\"16\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Alcohol<br \/>\r\n                    <span class=\"label-lighter\">&ge; 8 units\/week<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-3\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"alcohol\" id=\"medical-calculator-has-bled-alcohol-n\" value=\"N\" tabindex=\"17\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"alcohol\" id=\"medical-calculator-has-bled-alcohol-y\" value=\"Y\" tabindex=\"18\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n        <\/form>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12\">\r\n                <div id=\"medical-calculator-has-bled-result-text\" class=\"result-text\">\r\n                    <p><h5>\r\n                                                HAS-BLED Score:\r\n                         <span id=\"medical-calculator-has-bled-result-value\"><\/span><\/h5><\/p>\r\n                    <p id=\"medical-calculator-has-bled-result-interpretation\"><\/p>\r\n                    <p>\r\n                        <ul>\r\n                            <li>\r\n                            <span id=\"medical-calculator-has-bled-result-bleedings-per100y\"><\/span>\r\n                                                            bleedings per 100 patient-years\r\n                                                        <\/li>\r\n                            <li>                            Risk for major bleeding:\r\n                                                        <span id=\"medical-calculator-has-bled-result-severe-bleedings-risk\"><\/span>\r\n                            <\/li>\r\n                        <\/ul>\r\n                    <\/p>\r\n                    <p>                        Recommendation:\r\n                                        <span id=\"medical-calculator-has-bled-result-recommendation\"><\/span>\r\n                    <\/p>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12\">\r\n            <p>\r\n                                ULN = upper limit of normal, ASAT = aspartate transaminase, ALAT = alanine transaminase, AP = alkaline phosphatase, INR = international normalized ratio, NSAID = non-steroidal anti-inflammatory drugs\r\n                            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12 mt-3\">\r\n                <h5>\r\n                                            Interpretation\r\n                                    <\/h5>\r\n                <div class=\"table-responsive-sm\">\r\n                    <table class=\"table table-bordered\">\r\n                        <thead>\r\n                            <tr>\r\n                                <th>\r\n                                                                            Points\r\n                                                                    <\/th>\r\n                                <th>\r\n                                                                            Bleedings per 100 patient-years <a href=\"#has-bled-cite-note-1\">[1]<\/a>\r\n                                                                    <\/th>\r\n                                <th>\r\n                                                                            Risk for major bleeding <a href=\"#has-bled-cite-note-3\">[3]<\/a>\r\n                                                                    <\/th>\r\n                                <th>\r\n                                                                            Recommendation\r\n                                                                    <\/th>\r\n                            <\/tr>\r\n                        <\/thead>\r\n                        <tbody>\r\n                            <tr class=\"table-row-a\">\r\n                                <td>\r\n                                                                            0\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            1.13\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            0.9 %\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            <p>Low risk for major bleeding<\/p>\r\n                                        <p>Anticoagulation should be considered<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-b\">\r\n                                <td>\r\n                                                                            1\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            1.02\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            3.4 %\r\n                                                                    <\/td>\r\n                                <td rowspan=\"2\">\r\n                                                                            <p>Moderate risk for major bleeding<\/p>\r\n                                        <p>Anticoagulation may be considered<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-c\">\r\n                                <td>\r\n                                                                            2\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            1.88\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            4.1 %\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-d\">\r\n                                <td>\r\n                                                                            3\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            3.74\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            5.8 %\r\n                                                                    <\/td>\r\n                                <td rowspan=\"3\">\r\n                                                                            <p>High risk of major bleeding<\/p>\r\n                                        <p>Caution with anticoagulation. Alternatives should be considered.<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-e\">\r\n                                <td>\r\n                                                                            4\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            8.7\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            8.9 %\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-f\">\r\n                                <td>\r\n                                                                            5\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            12.5\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            9.1 %\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-g\">\r\n                                <td>\r\n                                                                            &gt; 5\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            -\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            -\r\n                                                                    <\/td>\r\n                                <td>\r\n                                                                            Very high risk of major bleeding\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                        <\/tbody>\r\n                    <\/table>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12 mt-3\">\r\n                <h5>\r\n                                            References\r\n                                    <\/h5>\r\n                <ol class=\"references\">\r\n                    <li id=\"has-bled-cite-note-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<\/li>\r\n                    <li id=\"has-bled-cite-note-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:<\/li>\r\n                    <li id=\"has-bled-cite-note-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<\/li>                    \r\n                <\/ol>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n    <script type=\"text\/javascript\">\r\n                var medical_calculator_has_bled_messages = {\r\n            'interpretation_0' : 'Low risk for major bleeding',\r\n            'interpretation_1-2' : 'Moderate risk for major bleeding',\r\n            'interpretation_3-5' : 'High risk of major bleeding',\r\n            'interpretation_lt5' : 'Very high risk of major bleeding',\r\n            'recommendation_0' : 'Anticoagulation should be considered',\r\n            'recommendation_1-2' : 'Anticoagulation may be considered',\r\n            'recommendation_3-5' : 'Caution with anticoagulation. Alternatives should be considered.',\r\n            'recommendation_lt5' : '-',\r\n            'point' : 'point',\r\n            'points' : 'points'\r\n        };\r\n            <\/script>\r\n\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":28833,"menu_order":131,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-28863","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28863","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/comments?post=28863"}],"version-history":[{"count":1,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28863\/revisions"}],"predecessor-version":[{"id":28864,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28863\/revisions\/28864"}],"up":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28833"}],"wp:attachment":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/media?parent=28863"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}