HAS-BLED Score
The HAS-BLED score is a widely recognized and validated tool used to assess the one-year risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants. It was developed in 2010, using data from the EuroHeart survey.
Components of the HAS-BLED Score
The HAS-BLED score is an acronym that stands for:
- Hypertension
- Abnormal renal/liver function
- Stroke
- Bleeding history or predisposition
- Labile INR (International Normalized Ratio)
- Elderly (age > 65 years)
- Drugs/alcohol concomitantly
Each component is assigned 1 point, with a maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or liver function, previous stroke, history of bleeding, unstable anticoagulation control, advanced age, and the use of certain medications or alcohol.
Interpretation of HAS-BLED score
- A score of 0-1 indicates low risk
- A score of 2 suggests moderate risk
- A score of 3 or higher indicates high risk of major bleeding
Note that a high HAS-BLED score should not be used as a reason to withhold anticoagulation therapy. Instead, it serves as a tool to identify patients who may require more careful monitoring and management of modifiable risk factors.
The HAS-BLED score has demonstrated moderate predictive abilities for bleeding risks in AF patients, regardless of the type of oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such as HEMORR2HAGES, ATRIA, ORBIT, and GARFIELD-AF scores. Moreover, the HAS-BLED score has been found to be predictive of intracranial hemorrhage, which is considered the most devastating complication related to anticoagulation use.