HAS-BLED Calculator

The HAS-BLED score is a clinical prediction tool designed to assess the risk of major bleeding in patients with atrial fibrillation (AF) who are receiving anticoagulation therapy. Healthcare providers use this scoring system to balance the benefits and risks of anticoagulation, tailoring treatment plans to minimize bleeding risk while maintaining stroke prevention.

The HAS-BLED score is widely used in clinical practice due to its ability to effectively identify patients at an increased risk of bleeding.

The HAS-BLED score is calculated by assigning points to various bleeding risk factors as follows:

• Hypertension (uncontrolled): 1 point
• Abnormal Renal Function (e.g., dialysis, renal transplantation, or serum creatinine ≥ 200 μmol/L): 1 point
• Abnormal Liver Function (e.g., cirrhosis or biochemical evidence of significant liver dysfunction): 1 point
• Stroke history: 1 point
• Bleeding history or predisposition: 1 point
• Labile International Normalized Ratio (INR) in patients on warfarin: 1 point
• Elderly (Age > 65 years): 1 point
• Drugs (concomitant use of antiplatelet agents, nonsteroidal anti-inflammatory drugs): 1 point
• Prior Alcohol or Drug Usage History: 1 Point

The total score ranges from 0 to 9, with higher scores indicating a higher risk of major bleeding.

The HAS-BLED score helps healthcare providers identify patients with a higher risk of bleeding during anticoagulation therapy. It is essential to weigh the benefits of stroke prevention against the risks of bleeding when making treatment decisions. Patients with a HAS-BLED score of 3 or higher are considered to be at high risk for bleeding.

In patients with a high HAS-BLED score, it is crucial to address modifiable risk factors (e.g., uncontrolled hypertension, concomitant medication use) and reassess the bleeding risk regularly. A high HAS-BLED score should not automatically preclude anticoagulation therapy but should prompt the provider to take appropriate measures to mitigate bleeding risk.

The HAS-BLED score is a valuable tool for healthcare providers to assess bleeding risk in patients with AF receiving anticoagulation therapy. It allows for a more individualized approach to treatment, ensuring that the benefits of stroke prevention are balanced against the risk of bleeding complications.

References:

• Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J., & Lip, G. Y. (2010). 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, 138(5), 1093-1100.
• Lip, G. Y., Frison, L., Halperin, J. L., & Lane, D. A. (2011). 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. Journal of the American College of Cardiology, 57(2), 173-180.