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Bleeding Risk Assessment

The HAS-BLED score for estimating the risk of major bleeding among AF patients is based on the presence of hypertension, abnormal liver or renal function, history of stroke or bleeding, labile INRs, elderly age (>65 years), and concomitant use of drugs that promote bleeding or excess alcohol use and was derived from the European Heart Survey on AF. The proposed schema relies on fewer and more readily obtained risk factors than earlier schemata do. Documentation of a HAS-BLED score allows the clinician to assign the patient a risk of major bleeding ranging from about 1% (score 0-1) to 12.5% (score 5) and can be useful in decisions about the relative risks of stroke vs major bleeding with various antithrombotic therapies. Patients at high risk of major bleeding warrant caution in the use of antithrombotic therapies and closer monitoring and follow-up.

Clinical Characteristic Score
Hypertension 1
Abnormal renal or liver function (1 point each) 1 or 2
Stroke 1
Bleeding 1
Labile INRs 1
Elderly (eg, age >65 yr) 1
Drugs or alcohol (1 point each) 1 or 2

Risk Factor Score Major Bleeds (% per year)
0 1.13
1 1.02
2 1.88
3 3.74
4 8.70
5 12.50
 

Reference:

R. Pisters, D.A. Lane and R. Nieuwlaat, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest, 138 (2010), pp. 1093–1100.