HAS-BLED Bleeding Risk Score
HAS-BLED (Pisters 2010); interpretation per ESC 2020 AF guidelineCounts nine one-point bleeding-risk factors in anticoagulated (or candidate) atrial-fibrillation patients; a score of 3 or more flags high bleeding risk and prompts correction of modifiable factors rather than withholding anticoagulation.
Also searched as: atrial fibrillation · anticoagulation · warfarin · DOAC · af
Lower concern
HAS-BLED 0
Score: 0
- Total score: 0 of 9 (0-2 low/moderate, >= 3 high bleeding risk).
- No risk factors present.
- Bleeding risk not in the high range; routine monitoring per anticoagulant and renal function.
Caveats
- Use alongside CHA2DS2-VASc, never instead of it.
- Labile INR applies only to vitamin-K-antagonist therapy.
How this tool works
HAS-BLED scores uncontrolled hypertension (systolic over 160), abnormal renal function, abnormal liver function, prior stroke, bleeding history or predisposition, labile INR on warfarin, age over 65, concomitant antiplatelet/NSAID drugs, and alcohol excess at one point each (maximum 9). A score of 3 or more denotes high bleeding risk: guidelines direct clinicians to schedule early and frequent review and to correct reversible contributors (blood-pressure control, minimizing interacting drugs, alcohol reduction, INR quality on warfarin). Critically, a high HAS-BLED is not a contraindication to oral anticoagulation — it identifies patients needing risk-factor management, not patients to be denied stroke prevention.
References
- Pisters R, et al. Chest 2010;138:1093-1100
- 2020 ESC Guidelines, atrial fibrillation. Eur Heart J 2021;42:373-498
Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.