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Bayan covers OMSB Part 1 & 2, Arab Board, SCFHS, MRCP(UK) Part 1, and ABIM Internal Medicine board exams with exam-specific blueprints and study plans.

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Home/Calculators/HAS-BLED Score

HAS-BLED Score

Estimates major bleeding risk in patients on anticoagulation for atrial fibrillation

When to Use

Patients with atrial fibrillation on or being considered for anticoagulation
Assessing modifiable bleeding risk factors before starting OAC
Perioperative bleeding risk assessment in anticoagulated AF patients

When NOT to Use

Should NOT be used to withhold anticoagulation in high-risk AF patients
Not validated for patients on anticoagulation for indications other than AF
Not a substitute for clinical judgment in active bleeding

Running Total0 / 9

Hypertension (uncontrolled, systolic BP >160 mmHg)(+1 point)

Abnormal renal function (dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L)(+1 point)

Abnormal liver function (cirrhosis, bilirubin >2× ULN, AST/ALT/ALP >3× ULN)(+1 point)

Stroke history(+1 point)

Bleeding history or predisposition (prior major bleed, anemia, bleeding diathesis)(+1 point)

Labile INR (unstable/high INRs, time in therapeutic range <60%) — warfarin only(+1 point)

Elderly (age >65 years)(+1 point)

Drugs predisposing to bleeding (antiplatelets, NSAIDs)(+1 point)

Alcohol excess (≥8 drinks/week)(+1 point)

Major Bleeding Risk by Score

Score 0

1.13 bleeds per 100 patient-years

Score 1

1.02 bleeds per 100 patient-years

Score 2

1.88 bleeds per 100 patient-years

Score 3

3.74 bleeds per 100 patient-years

Score 4

8.70 bleeds per 100 patient-years

Score ≥5

12.50 bleeds per 100 patient-years

Clinical Pearl

HAS-BLED \u22653 should trigger review of modifiable risk factors, NOT automatic withholding of anticoagulation. ESC 2020 guidelines explicitly state this. The score is meant to identify patients who need closer monitoring and risk factor optimization, not to deny them the benefits of stroke prevention with OAC.

Evidence & References

Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. 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(5):1093-1100.PMID: 20299623
Hindricks G, Potpara T, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42(5):373-498.PMID: 32860505
Douketis JD, Spyropoulos AC, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation (BRIDGE Trial). N Engl J Med. 2015;373(9):823-833.PMID: 26095867

Disclaimer: This calculator is a clinical decision aid and does not replace clinical judgment. Always consider the full clinical context when making patient care decisions.