HAS-BLED Score

What is the HAS-BLED score?

HAS-BLED is a simple clinical score (0–9) used to estimate bleeding risk in atrial fibrillation and to highlight modifiable bleeding risk factors.

Source note: The HAS-BLED score was originally derived and published by Pisters et al. (CHEST, 2010). In clinical practice, the score is mainly used to identify modifiable bleeding risk factors and to guide follow-up intensity, not as a standalone reason to withhold anticoagulation.

How is it calculated?

• H — Hypertension: SBP >160 mmHg (1 point).
• A — Abnormal renal function (1 point).
• A — Abnormal liver function (1 point).
• S — Prior stroke (1 point).
• B — Bleeding history/predisposition (1 point).
• L — Labile INR (TTR <60%) (1 point; mainly for warfarin).
• E — Elderly: age >65 years (1 point).
• D — Drugs (antiplatelet/NSAID) and Alcohol (harmful use): 1 point each.

Interpretation

• LOW (0–1): lower bleeding risk.
• MODERATE (2): moderate bleeding risk.
• HIGH (≥3): high bleeding risk — closer follow-up and aggressive modification of risk factors.

How to use the result

This tool supports clinical judgment and should be used within local protocols. A high HAS-BLED score should prompt risk-factor modification and closer monitoring, not automatic avoidance of anticoagulation.

• Control blood pressure and treat reversible causes of anemia or bleeding.
• Review concomitant medications (avoid unnecessary antiplatelets/NSAIDs).
• If on warfarin, improve INR control (TTR). Consider DOACs when appropriate.
• Reduce harmful alcohol use.
• Reassess bleeding and stroke risks periodically.