Pisters et al reported the HAS-BLED score for predicting the 1-year risk of major bleeding in a patient taking oral anticoagulants for atrial fibrillation. The authors are participants in the Euro Heart Survey (see also the CHA2DS2-VASc score).
Patient selection: atrial fibrillation taking oral anticoagulation, with CHADS2 score >= 1
Outcome: major bleeding over 1 year (intracranial hemorrhage, hospitalization for bleeding, drop in hemoglobin > 2 g/dL, blood transfusion)
Parameters:
(1) hypertension (H)
(2) abnormal liver and renal function (A)
(3) stroke (S)
(4) bleeding history or predispositoin (B)
(5) labile INR (L)
(6) elderly (E)
(7) drugs or alcohol (D)
Parameter
Finding
Points
hypertension (systolic blood pressure > 160 mm Hg)
absent
0
present
1
liver function
normal
abnormal
renal function
stroke
bleeding
INR
stable
labile
age
<= 65 years
> 65 years (elderly)
alcohol use
therapy with antiplatelet drugs or NSAIDS
total score =
= SUM(points for all 9 items)
Interpretation:
• minimum score: 0
• maximum score: 9 (maximum score in the Euro Heart Survey was 5)
• The higher the score the greater the risk of bleeding.
Total Score
Major Bleeds per 100 Patient Years
0 or 1
2
1.9
3
3.7
4
8.7
5
12.5
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Purpose: To identify a patient with atrial fibrillation who is likely to have a major bleed during oral anticoagulation using the HAS-BLED score.
Specialty: Hematology Oncology, Clinical Laboratory, Pharmacology, clinical
Objective: risk factors, severity, prognosis, stage
ICD-10: I48,
