The HAS-BLED score is a clinical tool used to estimate the risk of major bleeding in patients taking anticoagulants, especially in the context of atrial fibrillation. The acronym “HAS-BLED” provides a mnemonic to remember the factors considered in this scoring system.
Here’s a brief outline of the components of the HAS-BLED score:
- H: Hypertension (systolic >160 mmHg) – 1 point
- A: Abnormal liver function (e.g., cirrhosis, bilirubin >2x upper limit of normal with AST/ALT/AP >3x upper limit normal) OR abnormal renal function (e.g., chronic dialysis, renal transplantation, serum creatinine >200 µmol/L) – 1 point each (liver + kidney)
- S: Stroke history – 1 point
- B: Bleeding history or predisposition (e.g., anemia) – 1 point
- L: Labile International Normalized Ratios (INRs) (if on warfarin and unstable INRs or time in therapeutic range <60%) – 1 point
- E: Elderly (age >65 years) – 1 point
- D: Drugs (concomitant use of drugs increasing bleeding risk e.g., antiplatelet agents, NSAIDs) or alcohol use (≥8 drinks/week) – 1 point each (drugs + alcohol)
The total score can range from 0 to 9 points.
Interpretation:
- 0-1: Low risk of bleeding
- 2: Moderate risk of bleeding
- 3 or higher: High risk of bleeding
The HAS-BLED score is used to highlight potential modifiable bleeding risk factors in patients, and it assists in the decision-making process regarding anticoagulation. However, a high HAS-BLED score alone should not necessarily exclude patients from anticoagulant therapy, but rather indicates that regular reviews and careful monitoring are required. As always, individual clinical judgment and patient preferences are crucial when making treatment decisions.
Note that age, hypertension, and Hx of thromboembolism are common to both CHA₂DS₂-VASc and HAS-BLED.