Assess the risk of major bleeding in patients with atrial fibrillation who are candidates for anticoagulation therapy. Use this tool alongside the CHA2DS2-VASc score to make informed treatment decisions.
HAS-BLED Score: 0
Annual Major Bleeding Risk:
Interpretation:
The HAS-BLED score is a clinical prediction rule designed to estimate the 1-year risk of major bleeding in patients with atrial fibrillation who are receiving anticoagulation therapy. It was developed to help clinicians identify patients at higher risk of bleeding complications.
The acronym stands for: Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly (>65 years), and Drugs/alcohol concomitantly. Each factor contributes 1 point to the total score.
Important: The HAS-BLED score should primarily be used to identify modifiable bleeding risk factors (such as uncontrolled hypertension, excessive alcohol use, or concomitant antiplatelet therapy) rather than to withhold anticoagulation from high stroke-risk patients.
| Score | Annual Bleeding Risk | Risk Category |
|---|---|---|
| 0-2 | 1.02% - 1.88% | Low to Moderate Risk |
| ≥3 | 3.74% - 12.50% | High Risk |
Score 0-2: Low to moderate bleeding risk. Anticoagulation should be considered based on stroke risk assessment using the CHA2DS2-VASc calculator.
Score ≥3: High bleeding risk. Focus on addressing modifiable risk factors. Consider more frequent monitoring and patient education. Anticoagulation may still be appropriate if stroke risk is high.
A 68-year-old male patient with atrial fibrillation is being considered for anticoagulation. He has a history of uncontrolled hypertension (BP 170/95 mmHg), previous stroke, and drinks 10 alcoholic beverages per week.
✓ Hypertension (Uncontrolled): +1 point
✓ Stroke History: +1 point
✓ Elderly (Age >65 years): +1 point
✓ Drugs/Alcohol (≥8 drinks/week): +1 point
Total HAS-BLED Score: 4 points
Annual bleeding risk: 8.70% - High risk
Management: Address modifiable factors (blood pressure control, alcohol reduction) while considering anticoagulation if stroke risk is high.
Cardiology, Electrophysiology
Dr. Eleanor Vance is a board-certified cardiologist with over 15 years of experience specializing in cardiac electrophysiology and the management of atrial fibrillation. After graduating summa cum laude from Johns Hopkins School of Medicine, she completed her residency at Massachusetts General Hospital and a fellowship in cardiology at the Cleveland Clinic.
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