HAS-BLED score

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Editors-in-Chief: Gregory Lip, MD [1] and C. Michael Gibson, M.S., M.D. [2]

Overview

A therapeutic bleeding risk stratification score for those on oral anticoagulants in atrial fibrillation[1]. 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[2].

HAS-BLED score for bleeding risk on oral anticoagulation in atrial fibrillation
Feature Score if present
Hypertension (Systolic ≥ 160mmHg) 1
Abnormal renal function 1
Abnormal liver function 1
Age ≥ 65 years 1
Stroke in past 1
Bleeding 1
Labile INRs 1
Taking other drugs as well 1
Alcohol intake at same time 1

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 [3] and the Canadian guidelines [4] 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).

References

  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.(Epub ahead of print) (Link to article – subscription may be required.)
  2. Lip GY, Frison L, Halperin JL, Lane DA (January 2011). "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". Journal of the American College of Cardiology 57 (2): 173–80. doi:10.1016/j.jacc.2010.09.024. PMID 21111555. Retrieved on 2011-01-24.
  3. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429.
  4. Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M; CCS Atrial Fibrillation Guidelines Committee. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol. 2011 Jan-Feb;27(1):74-90.

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