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Bleeding risk: HAS-BLED bleeding risk score
Bleeding risk: HAS-BLED bleeding risk score [Explained]
Feel free to use our complete database with charts, tables and examples.
HAS-BLED bleeding risk score
HAS-BLED scoring system was developed to assess the one year risk of major bleeding (intracranial bleedings, hospitalization, hemoglobin decrease > 2 g/dL, and/or transfusion) in patients taking anticoagulants with atrial fibrillation. It was developed in 2010 with data from 3,978 patients in the Euro Heart Survey.
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Clinical feature / Points
H
Hypertension
-
( systolic blood pressure >160 mmHg)
(Points: 1 )
A
Abnormal renal function
( defined as the presence of chronic dialysis or renal transplantation
or serum creatinine
200µmol/L (>~2.3 mg/dL))
(Points: 1 )
Abnormal liver function
( defined as chronic hepatic disease (eg. cirrhosis) or biochemical
evidence of significant hepatic derangement (eg. bilirubin >2x upper limit of normal, in association
with AST/ALT/ALP >3x upper limit normal)
(Points: 1 )
S
Stroke
(Previous history of stroke)
(Points: 1 )
B
Bleeding
(Major bleeding history (anemia or predisposition to bleeding))
(Points: 1 )
L
Labile INRs
(refers to unstable/high INRs or poor time in therapeutic range(eg<60%))
(Points: 1)
E
Elderly
(age >/= 65) (Points: 1 )
D
Drug Therapy
(concomitant therapy such as antiplatelet agents, NSAID's)
(Points: 1 )
Alcohol intake
(consuming 8 or more alcoholic drinks per week)
(Points: 1)
Background
HAS-BLED: acronym of the major factors associated with bleeding risk in patients with atrial fibrillation receiving oral anticoagulation.
Clinical Characteristics Composing the HAS-BLED Bleeding Risk Score
Letter
Clinical Characteristic
Points Awarded
H
Hypertension
1
A
Abnormal renal and liver function (1 point each)
1 or 2
S
Stroke
1
B
Bleeding
1
L
Labile INRs
1
E
Elderly
1
D
Drugs or alcohol (1 point each)
1 or 2
Maximum possible score is 9
The risk of major bleeding within one year in atrial fibrillation patients enrolled in the Euro Heart Survey
.
HAS-BLED, acronym: Hypertension [uncontrolled, >160 mmHg systolic), Abnormal renal/liver function, Stroke, Bleeding history or predisposition [anemia], Labile INR [i.e.
therapeutic time in range <60%], Elderly (>65) and Drugs/alcohol concomitantly [antiplatelet agents, non-steroidal anti-inflammatory drugs] [Maximum score 9].
HAS-BLED score
n
Bleeds, n
Bleeds/100 patients*
0
798
9
1.13
1
1286
13
1.02
2
744
14
1.88
3
187
7
3.74
4
46
4
8.70
5
8
1
12.50
Any score
3071
48
1.56
References
:
[1 ] Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. "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 Mar 18.
[2 ] Lip GYH, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011;57:173– 80.
[3] Lip GY. Implications of the CHA(2)DS(2)-VASc and HAS-BLED Scores for thromboprophylaxis in atrial fibrillation. Am J Med. 2011 Feb;124(2):111-4. doi: 10.1016/j.amjmed.2010.05.007. Epub 2010 Sep 29. [
PubMed
]
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