HAS-BLED bleeding risk score
HAS-BLED scoring system was developed to assess the one year risk of major bleeding (intracranial bleedings, hospitalization, hemoglobin decrease > 2 g/dL, and/or transfusion) in patients taking anticoagulants with atrial fibrillation. It was developed in 2010 with data from 3,978 patients in the Euro Heart Survey.
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Clinical feature / Points
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H
Hypertension -(
systolic blood pressure >160 mmHg) (Points: 1 ) |
A
Abnormal renal function (
defined as the presence of chronic dialysis or renal transplantation
or serum creatinine  200µmol/L
(>~2.3 mg/dL)) (Points: 1 )
Abnormal liver function (
defined as chronic hepatic disease (eg. cirrhosis) or biochemical
evidence of significant hepatic derangement (eg. bilirubin >2x upper
limit of normal, in association
with AST/ALT/ALP >3x upper limit normal) (Points: 1 ) |
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S
Stroke (Previous
history of stroke) (Points: 1 ) |
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B
Bleeding (Major bleeding
history (anemia or predisposition to bleeding)) (Points: 1 ) |
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L
Labile
INRs (refers to unstable/high INRs
or poor time in therapeutic range(eg<60%))(Points: 1) |
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E
Elderly (age >/= 65) (Points: 1 ) |
D
Drug Therapy (concomitant
therapy such as
antiplatelet agents, NSAID's) (Points: 1 )
Alcohol intake (consuming 8
or more alcoholic drinks per week) (Points: 1) |
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Background
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HAS-BLED: acronym of the major factors associated with bleeding risk in patients
with atrial fibrillation receiving oral anticoagulation.
Clinical Characteristics Composing the HAS-BLED Bleeding Risk Score
| Letter |
Clinical Characteristic |
Points Awarded |
| H |
Hypertension |
1 |
| A |
Abnormal renal and liver function (1 point each) |
1 or 2 |
| S |
Stroke |
1 |
| B |
Bleeding |
1 |
| L |
Labile INRs |
1 |
| E |
Elderly |
1 |
| D |
Drugs or alcohol (1 point each) |
1 or 2 |
| Maximum possible score is 9 |
The risk of major bleeding within
one year in atrial fibrillation patients enrolled in the Euro Heart
Survey.
HAS-BLED, acronym: Hypertension [uncontrolled, >160 mmHg systolic),
Abnormal renal/liver function, Stroke, Bleeding history or
predisposition [anemia], Labile INR [i.e.
therapeutic time in range <60%], Elderly (>65) and Drugs/alcohol
concomitantly [antiplatelet agents, non-steroidal anti-inflammatory
drugs] [Maximum score 9]. |
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HAS-BLED score |
n |
Bleeds, n |
Bleeds/100 patients* |
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0 |
798 |
9 |
1.13 |
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1 |
1286 |
13 |
1.02 |
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2 |
744 |
14 |
1.88 |
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3 |
187 |
7 |
3.74 |
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4 |
46 |
4 |
8.70 |
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5 |
8 |
1 |
12.50 |
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Any score |
3071 |
48 |
1.56 |
References:
[1 ] Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. "A novel
user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in
atrial fibrillation patients: The Euro Heart Survey." Chest. 2010 Mar 18.
[2 ] Lip GYH, Frison L, Halperin JL, Lane DA. 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– 80.
[3] Lip GY. Implications of the CHA(2)DS(2)-VASc and HAS-BLED Scores for
thromboprophylaxis in atrial fibrillation. Am J Med. 2011 Feb;124(2):111-4. doi:
10.1016/j.amjmed.2010.05.007. Epub 2010 Sep 29. [PubMed]
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