HAS-BLED

HAS-BLED is a clinical prediction rule used to estimate the risk of major bleeding for patients on anticoagulation for atrial fibrillation (AF). It is often used in conjunction with the CHA2DS2-VASc score, which estimates the risk of stroke in patients with AF. The HAS-BLED score is calculated based on the presence of certain risk factors, each of which contributes one point to the total score.

Calculation

The HAS-BLED score is calculated as follows:

• Hypertension: 1 point
• Abnormal renal/liver function: 1-2 points
• Stroke: 1 point
• Bleeding history or predisposition: 1 point
• Labile INR: 1 point
• Elderly (age >65 years): 1 point
• Drugs/alcohol concomitantly: 1-2 points

A score of 0-1 indicates a low risk of major bleeding, while a score of 2 or more indicates a high risk.

Clinical Use

The HAS-BLED score is used to guide anticoagulation therapy in patients with AF. A high score may indicate a need for more frequent monitoring or a reconsideration of the risks and benefits of anticoagulation therapy. However, it should not be used in isolation to withhold anticoagulation in patients with a high risk of stroke.

Limitations

While the HAS-BLED score is a useful tool, it has some limitations. It does not account for all possible risk factors for bleeding, and it may overestimate the risk in some patients. Furthermore, the score has not been validated in all patient populations.

See Also

• CHA2DS2-VASc score
• Atrial fibrillation
• Anticoagulation

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