You are here
Home > Medical Calculator > Bleeding risk: HAS-BLED bleeding risk score

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.
« Back

Clinical feature /   Points

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 geq200µmol/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 )
S Stroke (Previous history of stroke) (Points: 1 )
B Bleeding (Major bleeding history (anemia or predisposition to bleeding))  (Points: 1 )
L Labile INRs (refers to unstable/high INRs or poor time in therapeutic range(eg<60%))(Points: 1)
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)


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].
HAS-BLED score n Bleeds, n Bleeds/100 patients*
0 798 9 1.13
1 1286 13 1.02
2 744 14 1.88
3 187 7 3.74
4 46 4 8.70
5 8 1 12.50
Any score 3071 48 1.56

[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]

Warfarin related Links


The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer