HAS-BLED score

CARDIOLOGY, MNEMONICS

The HAS-BLED score estimates the 1-year risk of major bleeding for patients on anticoagulation for atrial fibrillation.  Prior to the publication of the HAS-BLED manuscript in 2010, an older, more complicated algorithm called HEMORR2HAGES was used.

HAS-BLED has a total of 9 parameters. Each parameter is allotted 1 point. The letters L & D each represent two parameters. Every other letter represents one parameter.

The original HAS-BLED acronym stands for Hypertension, Abnormal liver/renal function, Stroke history, Bleeding history or predisposition, Labile INR, Elderly, Drug/alcohol usage.

I’ve slightly rearranged the HAS-BLED acronym below to make it easier to remember and keep it consistent with CHA2DS2-VASc while retaining all the parameters in the original acronym.

HAS-BLED Score

  • HTN (SBP>160)
  • Age >65
  • Stroke
  • Bleeding history or predisposition.
  • Liver and Kidney dysfunction. 1pt each, a total of 2pts.
  • Elevated or unstable INRs, time in the therapeutic range <60%
  • Drugs and Alcohol. Drugs – Antiplatelets (Aspirin, Clopidogrel, NSAIDs). Alcohol – more than 8 drinks per week –1pt each, a total of 2pts.

Definition of Parameters in the HAS-BLED mnemonic

HTN: (uncontrolled HTN, SBP>160)
Age: Greater than 65
Stroke: Patient has had a stroke in the past.
Bleeding: a history of major bleeding or predisposition to bleeding (anemia?)
Liver dysfunction: Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal
–Kidney dysfunction: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Elevated/unstable INRs: Elevated or unstable INRs, time in the therapeutic range <60%
Drugs and Drinks: Drugs – Antiplatelets (Aspirin, Clopidogrel, NSAIDs). Alcohol – more than 8 drinks per week –1pt each, a total of 2pts.

Definition of Major Bleeding

HAS-BLED estimates the 1-year risk for major bleeding in patients with atrial fibrillation. Major bleeding was defined as intracranial bleeding, bleeding requiring hospitalization, a hemoglobin decrease of > 2 g/dL, or the need for transfusion secondary to bleeding.

  • A score of 0 to 1: Low risk for major bleeding. Anticoagulation should be considered.
  • A score of 2: Moderate risk for major bleeding. Anticoagulation can be considered.
  • A score of 3: High risk for major bleeding. Alternatives to anticoagulation should be considered.

Online Calculators for the HAS-BLED score.

See here on ClinCalc.com. or on MDCalc.com.

Reference / Further Reading on the HAS-BLED score

Original Study
Chest. 2010 Nov;138(5):1093-100. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. https://www.ncbi.nlm.nih.gov/pubmed/20299623

Validation study
J Am Coll Cardiol. 2011 Jan 11;57(2):173-80. 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. https://www.ncbi.nlm.nih.gov/pubmed/21111555

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