HAS-BLED is a scoring system developed to assess 1-year risk of major

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

in people taking anticoagulants for atrial fibrillation (AF). It was developed in 2010 with data from 3,978 people in the Euro Heart Survey. Major bleeding is defined as being

intracranial bleeding Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds ( intraventricular bleeds and intraparenchymal bleeds), subarachnoid bleeds, epidural bleeds, and subdural bleed ...

hospitalization A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

, hemoglobin decrease > 2 g/dL, and/or transfusion.

Definition

HAS-BLED is a medical tool used to calculate the one-year risk of major bleeding for people on blood thinning drugs for atrial fibrillation (AF). It is used with the CHA₂DS₂-VASc score.

Use

A calculated HAS-BLED score is between 0 and 9 and based on seven parameters with a weighted value of 0-2. The HAS-BLED

mnemonic A mnemonic ( ) device, or memory device, is any learning technique that aids information retention or retrieval (remembering) in the human memory for better understanding. Mnemonics make use of elaborative encoding, retrieval cues, and imag ...

stands for: * Hypertension * Abnormal renal and liver function * Stroke * Bleeding * Labile INR * Elderly * Drugs or alcohol A study comparing HEMORR2HAGES, ATRIA and HAS-BLED showed superior performance of the HAS-BLED score compared to the other two. Mixed evidence exist on the comparison between GARFIELD-AF bleeding score over the HAS-BLED. 2020 ESC guidelines on atrial fibrillation recommend assessment of bleeding risk in AF using the HAS-BLED bleeding risk schema as a simple, easy calculation, whereby a score of ≥3 indicates "high risk" and some caution and regular review of the patient is needed. The HAS-BLED score has also been validated in an anticoagulated trial cohort of 7329 people with AF - in this study, the HAS-BLED score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply. With the likely availability of new oral anticoagulants that avoid the limitations of warfarin (and may even be safer), more widespread use of oral anticoagulation therapy for stroke prevention in AF is likely. While their use is recommended in clinical practice guidelines, they are only moderately effective in predicting bleeding risk and don't perform well in predicting hemorrhagic stroke. Bleeding risk may be increased in patients on

haemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...

Score

A score of ≥3 indicates "high risk", but does not necessarily mean that an anticoagulant cannot be given, as some risk factors may be modified.

References

{{Reflist Diagnostic cardiology Medical scoring system Medical mnemonics Mnemonic acronyms