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HAS-BLED Bleeding Risk Calculator

Estimates bleeding risk in patients with atrial fibrillation who are receiving anticoagulation therapy

Select all that apply:

Systolic blood pressure >160 mmHg

Dialysis, transplant, or serum creatinine ≥200 μmol/L

Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal

Previous stroke

Previous major bleeding or predisposition to bleeding

Unstable/high INRs, time in therapeutic range <60%

Age >65 years

Concomitant use of antiplatelets, NSAIDs, or alcohol abuse

About HAS-BLED Score

The HAS-BLED score is a clinical prediction tool used to estimate the risk of major bleeding in patients with atrial fibrillation who are receiving anticoagulation therapy. It helps clinicians balance the benefits of stroke prevention against the risks of bleeding.

Scoring System

  • Hypertension (uncontrolled): 1 point
  • Abnormal renal/liver function: 1 point each
  • Stroke: 1 point
  • Bleeding history or predisposition: 1 point
  • Labile INR: 1 point
  • Elderly (age >65 years): 1 point
  • Drugs/alcohol concomitantly: 1 point

Risk Categories & Clinical Guidance

  • Score 0-2: Low to moderate bleeding risk - Standard monitoring recommended
  • Score ≥3: High bleeding risk - Requires caution and regular review

Note: A high HAS-BLED score does not necessarily contraindicate anticoagulation but indicates need for careful monitoring and addressing modifiable risk factors.

Limitations

  • Designed specifically for patients with atrial fibrillation considering anticoagulation
  • Should be used alongside stroke risk assessment (CHA₂DS₂-VASc)
  • Clinical judgment should always supersede calculator results

Frequently Asked Questions

1. What is the HAS-BLED score used for?

The HAS-BLED score estimates the risk of major bleeding in patients with atrial fibrillation who are receiving anticoagulation therapy, helping clinicians balance benefits and risks.

2. What does a high HAS-BLED score mean?

A score of 3 or more indicates high risk of bleeding, requiring caution, regular review of anticoagulation therapy, and addressing modifiable risk factors.

3. How often should the HAS-BLED score be reassessed?

The score should be reassessed periodically, especially when new medical conditions develop or medications change.

4. Should anticoagulation be withheld if HAS-BLED score is high?

Not necessarily. A high score indicates need for caution and regular review, but the decision should balance bleeding risk against stroke risk (CHA₂DS₂-VASc score).