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Bleeding risk: HAS-BLED bleeding risk score [Explained]

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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 geq200µmol/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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Bleeding risk: HAS-BLED bleeding risk score