🩸 HAS-BLED Bleeding Risk Score
UseIdentify modifiable bleeding risk factors in AF anticoagulation decisions.
Strata≥ 3 flags high bleeding risk — prioritise fixing modifiable factors rather than automatically withholding ant…
LimitsDo not use HAS-BLED alone to deny OAC when stroke risk is high (weigh… · Labile INR applies to warfarin; DOAC patients need drug/alcohol and c… · Reassess after blood pressure, alcohol and interacting drugs are addr…
SourcePisters R, et al. Chest 2010
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Nonvalvular atrial fibrillation when deciding oral anticoagulation and the next step after bleeding.
- Who it is not for
- Valvular atrial fibrillation and mechanical valves do not use this card. Unrelated to PERC.
- Formula and variables
- Stroke risk uses CHA₂DS₂-VASc: heart failure, hypertension, age ≥75 (2), diabetes, prior stroke/TIA/embolism (2), vascular disease, age 65–74 and female sex, 1 point each. The 2024 ESC guideline uses CHA₂DS₂-VA without the sex item (≥2 recommend, 1 consider OAC); the 2023 ACC/AHA guideline still uses CHA₂DS₂-VASc (men ≥2, women ≥3). The 2023 China AF guideline uses CHA₂DS₂-VASc-60 (age 60–64 = 1, ≥65 = 2; OAC for men ≥2, women ≥3). This page scores the original CHA₂DS₂-VASc. Bleeding risk uses HAS-BLED.
- Result → next step
- Anticoagulation decisions open the atrial-fibrillation anticoagulation page: anticoagulate, hold for now, or individualize. A high bleeding score means fix reversible factors first; do not stop anticoagulation automatically. Bleeding opens the reversal page. No numeric reversal dose.AF anticoagulation →Anticoagulant reversal →
- Guideline
- China atrial fibrillation guideline 2023
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Use to address reversible factors, not to withhold anticoagulation.
When to use
Identify modifiable bleeding risk factors in AF anticoagulation decisions.
How it works
1 point each: hypertension, abnormal renal, abnormal liver, stroke, bleeding, labile INR, elderly (>65), drugs, alcohol. ≥ 3 = high risk.
Key points
- Use to address reversible factors, not to withhold anticoagulation.
- Weigh against stroke risk (CHA₂DS₂-VASc).
- Labile INR applies to warfarin (TTR < 60%).
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Uncontrolled hypertension (SBP > 160) | No |
|---|---|
| Abnormal renal function | No |
| Abnormal liver function | No |
| Stroke history | No |
| Prior major bleeding / predisposition | No |
| Labile INR (TTR < 60%) | No |
| Elderly (age > 65) | No |
| Drugs (antiplatelet/NSAID) | No |
| Alcohol ≥ 8 units/week | No |
→HAS-BLED0/9
- Interpretation：Lower bleeding risk.
| Uncontrolled hypertension (SBP > 160) | Yes |
|---|---|
| Abnormal renal function | Yes |
| Abnormal liver function | Yes |
| Stroke history | Yes |
| Prior major bleeding / predisposition | Yes |
| Labile INR (TTR < 60%) | Yes |
| Elderly (age > 65) | Yes |
| Drugs (antiplatelet/NSAID) | Yes |
| Alcohol ≥ 8 units/week | Yes |
→HAS-BLED9/9
- Interpretation：High bleeding risk — review modifiable factors, do not automatically withhold anticoagulation.
Verification & sources · governance
FAQ
Frequently asked questions
- Does HAS-BLED Bleeding Risk Score upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is HAS-BLED Bleeding Risk Score calculated in practice? Can you show a worked example?
- Inputs: Uncontrolled hypertension (SBP > 160) No, Abnormal renal function No, Abnormal liver function No, Stroke history No, Prior major bleeding / predisposition No, Labile INR (TTR < 60%) No, Elderly (age > 65) No, Drugs (antiplatelet/NSAID) No… → Result: HAS-BLED 0 /9（Interpretation: Lower bleeding risk.） Inputs: Uncontrolled hypertension (SBP > 160) Yes, Abnormal renal function Yes, Abnormal liver function Yes, Stroke history Yes, Prior major bleeding / predisposition Yes, Labile INR (TTR < 60%) Yes, Elderly (age > 65) Yes, Drugs (antiplatelet/NSAID) Yes… → Result: HAS-BLED 9 /9（Interpretation: High bleeding risk — review modifiable factors, do not automatically withhold anticoagulation.）