Bleeding Risk Assessment for Oral Anticoagulation HAS-BLED Score

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Bleeding Risk Assessment for Oral Anticoagulation HAS-BLED Score

Hypertension (Systolic BP > 160 mmHg)

Liver dysfunction (Liver enzymes > 3 times, bilirubin > 2 times)

Renal dysfunction (Creatinine ≥ 200 μmol/L or long-term dialysis or kidney transplant)

History of stroke

History of severe bleeding, bleeding tendency, etc.

Unstable INR (time out of range > 60%)

Age > 65 years

Concurrent use of antiplatelet agents, NSAIDs, etc.

Alcohol abuse (> 8 times/week)

Score:

Bleeding Risk:

Result Interpretation

Score	Bleeding Risk	1-Year Major Bleeding Risk
0	Low	0.6~1.13%
1	Moderate	1.02~1.5%
≥2	High	4.9~19.6%

A total score of 9 points. A score ≥ 3 indicates a high bleeding risk, requiring caution, and it is recommended to use oral anticoagulants (VK antagonists or aspirin) with close follow-up.

Explanation

The HAS-BLED score is derived from a global cohort study involving 3,978 patients with atrial fibrillation, designed to assess the risk of major bleeding within one year of oral anticoagulation therapy (including intracranial hemorrhage, requiring hospitalization, hemoglobin drop > 2g/L, and/or blood transfusion).

References

1. Pisters R, et al. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey. Chest. 2010;138(5):1093-100.

2. European Heart Rhythm Association, et al. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Guidelines for the management of atrial fibrillation. Eur Heart J. 2010;31(19):2369-429.

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