Clinical characteristics comprising the HAS-BLED bleeding risk score

Letter	Clinical characteristic*	Points
H	Hypertension (ie, uncontrolled blood pressure)	1
A	Abnormal renal and liver function (1 point each)	1 or 2
S	Stroke	1
B	Bleeding tendency or predisposition	1
L	Labile INRs (for patients taking warfarin)	1
E	Elderly (age greater than 65 years)	1
D	Drugs (concomitant aspirin or NSAIDs) or excess alcohol use (1 point each)	1 or 2
		Maximum 9 points

HAS-BLED score (total points)	Bleeds per 100 patient-years^¶
0	1.13
1	1.02
2	1.88
3	3.74
4	8.70
5 to 9	Insufficient data

The HAS-BLED bleeding risk score has only been validated in patients with atrial fibrillation receiving warfarin. Refer to UpToDate topics on anticoagulation in patients with atrial fibrillation and on specific anticoagulants for further information and other bleeding risk scores and their performance relative to clinical judgment.

INR: international normalized ratio; NSAIDs: nonsteroidal antiinflammatory drugs.
* Hypertension is defined as systolic blood pressure >160 mmHg. Abnormal renal function is defined as the presence of chronic dialysis, renal transplantation, or serum creatinine ≥200 micromol/L. Abnormal liver function is defined as chronic hepatic disease (eg, cirrhosis) or biochemical evidence of significant hepatic derangement (eg, bilirubin more than 2 times the upper limit of normal, plus 1 or more of aspartate transaminase, alanine transaminase, and/or alkaline phosphatase more than 3 times the upper limit of normal). Bleeding predisposition includes chronic bleeding disorder or previous bleeding requiring hospitalization or transfusion. Labile INRs for a patient on warfarin include unstable INRs, excessively high INRs, or <60% time in therapeutic range.
¶ Based on initial validation cohort from Pisters R. 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 2010; 138:1093. Actual rates of bleeding in contemporary cohorts may vary from these estimates.

Original figure modified for this publication. Lip GY. Implications of the CHA2DS2-VASc and HAS-BLED Scores for thromboprophylaxis in atrial fibrillation. Am J Med 2011; 124:111. Table used with the permission of Elsevier Inc. All rights reserved.

Graphic 75259 Version 16.0

خرید پکیج

Clinical characteristics comprising the HAS-BLED bleeding risk score