HAS-BLED score

Editors-in-Chief: Gregory Lip, MD [mailto:gregory.lip@gmail.com] and C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org]

Overview
A therapeutic bleeding risk stratification score for those on oral anticoagulants in atrial fibrillation. It is matched to the CHA2DS2-VASc score used for stroke risk stratification. In a recent article validating the score, diabetes and left ventricular dysfunction were identified as additional risk factors for bleeding.

Interpretation of the HAS-BLED Score
A score of 3 or more indicates an increased one year bleed risk on anticoagulation which would be sufficient to justify caution or more frequent evaluation. The risk is the risk of an intracranial bleed, bleeding requiring hospitalization or a hemoglobin drop > 2g/L or a bleeding episode that requires transfusion.

The HAS-BLED score is recommended within the new European Society of Cardiology guidelines and the Canadian guidelines  on atrial fibrillation management. This score would help as a potential practical tool in clinical decision making, rather than 'guessing' the bleeding risk. Also, the HAS-BLED score makes clinicians think about addressing any correctable bleeding risk factors (eg. uncontrolled hypertension, coadministration of NSAIDs or aspirin, etc).