HAS-BLED (Bleeding Risk on Anticoagulation)
Bleeding risk in patients on anticoagulation. Used alongside CHA₂DS₂-VASc.
About this calculator
The HAS-BLED score estimates 1-year major bleeding risk in atrial fibrillation patients on anticoagulation. Developed by Pisters et al. (Chest, 2010) in the Euro Heart Survey cohort. Each criterion 1 point, maximum 9: Hypertension SBP >160, Abnormal renal/liver function, Stroke history, Bleeding history, Labile INR, Elderly >65, Drugs (NSAIDs/antiplatelets), Alcohol >8 drinks/week. Interpretation. 0-2 – low bleeding risk (1-3% per year), standard anticoagulation. >=3 – high risk (5-10%+), review modifiable factors and increase monitoring. Clinical use. ESC 2024 and ACC/AHA 2023 recommend HAS-BLED as part of risk assessment before initiating anticoagulation in AF. A high score is NOT a reason to withhold anticoagulation – ischemic stroke risk without therapy usually exceeds bleeding risk. High score is a cue to address modifiable factors: control BP <140/90, keep INR in 2-3 range for warfarin or switch to DOAC, limit alcohol, discontinue unnecessary NSAIDs and antiplatelets, assess renal function. DOAC and HAS-BLED. With direct oral anticoagulants (apixaban, rivaroxaban, dabigatran, edoxaban) HAS-BLED still applies but the >=3 threshold is less predictive – DOACs reduce absolute intracranial bleeding risk by 50% vs warfarin. Anticoagulation decision balances CHA2DS2-VASc (stroke risk) against HAS-BLED (bleeding risk). Limitations. Does not capture anemia, thrombocytopenia, cancer (ORBIT is more accurate for these). Not validated in patients on triple antithrombotic therapy after PCI. After age 65 the score is automatically >=1 – in older patients bleeding risk is almost always moderate-to-high, reducing the score's discrimination.
Source
Formula version: 2010-v1
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