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 |
0 |
|
|
abnormal |
1 |
|
renal function |
normal |
0 |
|
|
abnormal |
1 |
|
stroke |
absent |
0 |
|
|
present |
1 |
|
bleeding |
absent |
0 |
|
|
present |
1 |
|
INR |
stable |
0 |
|
|
labile |
1 |
|
age |
<= 65 years |
0 |
|
|
> 65 years (elderly) |
1 |
|
alcohol use |
absent |
0 |
|
|
present |
1 |
|
therapy with antiplatelet drugs or NSAIDS |
absent |
0 |
|
|
present |
1 |
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 |
1 |
|
2 |
1.9 |
|
3 |
3.7 |
|
4 |
8.7 |
|
5 |
12.5 |
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,
