HAS-BLED Bleeding Risk Score — Free Medical Calculator

When to use: Use HAS-BLED alongside CHA₂DS₂-VASc when considering anticoagulation in AF. A high HAS-BLED score (≥3) should prompt correction of modifiable bleeding risk factors (BP control, stop NSAIDs, reduce alcohol) rather than withholding anticoagulation, as stroke risk typically outweighs bleeding risk at high CHA₂DS₂-VASc scores.

Key Points for NEET PG

Mnemonic: H-A-S-B-L-E-D — Hypertension, Abnormal renal/liver function, Stroke history, Bleeding history/predisposition, Labile INR, Elderly (>65), Drugs/alcohol.
Score ≥3 = high risk of major bleeding (~3.7% per year) — address modifiable factors, do NOT automatically withhold anticoagulation.
Labile INR (TTR <60%) is a key modifiable factor — switching to a DOAC eliminates the need for INR monitoring.
HAS-BLED is validated for warfarin; it underestimates bleeding risk with DOACs (use ORBIT score for DOACs in some guidelines).
Antiplatelet drugs (aspirin, clopidogrel) + anticoagulation significantly increases bleeding risk — avoid dual therapy unless mandatory (e.g., recent ACS/stenting, use for shortest duration).

References

Pisters R et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation · Chest (2010)

ESC Guidelines for the diagnosis and management of atrial fibrillation 2020 · Eur Heart J (2021)

For educational purposes only. Not for clinical decision-making without professional oversight.