HAS-BLED

HAS-BLED is a scoring system developed to assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation. It was developed in 2010 with data from 3,978 patients in the Euro Heart Survey.[1] Major bleeding is defined as being intracranial bleedings, hospitalization, hemoglobin decrease > 2 g/dL, and/or transfusion.[1]

Condition Points
 H   Hypertension: (uncontrolled, >160 mmHg systolic)
1
 A  Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L

Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal
1

1
 S  Stroke: Prior history of stroke
1
 B  Bleeding: Prior Major Bleeding or Predisposition to Bleeding
1
 L  Labile INR: (Unstable/high INR), Time in Therapeutic Range < 60%
1
 E  Elderly: Age > 65 years
1
 D  Prior Alcohol or Drug Usage History (≥ 8 drinks/week)

Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)
1

1
HAS-BLED score
Purposerisk of major bleeding

A calculated HAS-BLED score is between 0 and 9 and based on seven parameters with a weighted value of 0-2.

The HAS-BLED mnemonic stands for:

  • Hypertension
  • Abnormal renal and liver function
  • Stroke
  • Bleeding
  • Labile INR
  • Elderly
  • Drugs or alcohol


A study comparing HEMORR2HAGES, ATRIA and HAS-BLED showed superior performance of the HAS-BLED score compared to the other two.[2]

The new ESC guidelines on atrial fibrillation recommend assessment of bleeding risk in AF using the HAS-BLED bleeding risk schema as a simple, easy calculation,[1][3] whereby a score of ≥3 indicates "high risk" and some caution and regular review of the patient is needed.[4] The HAS-BLED score has also been validated in an anticoagulated trial cohort of 7329 patients with AF - in this study, the HAS-BLED score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply.[5] With the likely availability of new oral anticoagulants that avoid the limitations of warfarin (and may even be safer), more widespread use of oral anticoagulation therapy for stroke prevention in AF is likely.

While their use is recommended in clinical practice guidelines,[6] they are only moderately effective in predicting bleeding risk and don't perform well in predicting hemorrhagic stroke.[7] Bleeding risk may be increased in patients on haemodialysis.[8]

See also

References
  1. Pisters, Ron; Lane, D. A.; Nieuwlaat, R; De Vos, C. B.; Crijns, H. J.; Lip, G. Y. (2010). "A Novel User-Friendly Score (HAS-BLED) to Assess 1-Year Risk of Major Bleeding in Patients with Atrial Fibrillation". Chest. 138 (5): 1093–100. doi:10.1378/chest.10-0134. PMID 20299623.
  2. http://www.mdcalc.com/has-bled-score-for-major-bleeding-risk/%5B%5D
  3. "Archived copy". Archived from the original on 2015-04-02. Retrieved 2015-05-01.CS1 maint: archived copy as title (link)
  4. Lip, Gregory Y.H. (2011). "Implications of the CHA2DS2-VASc and HAS-BLED Scores for Thromboprophylaxis in Atrial Fibrillation". The American Journal of Medicine. 124 (2): 111–4. doi:10.1016/j.amjmed.2010.05.007. PMID 20887966.
  5. Lip, Gregory Y.H.; Frison, Lars; Halperin, Jonathan L.; Lane, Deirdre A. (2011). "Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients with Atrial Fibrillation". Journal of the American College of Cardiology. 57 (2): 173–80. doi:10.1016/j.jacc.2010.09.024. PMID 21111555.
  6. Camm, A. J.; Lip, G. Y. H.; De Caterina, R.; Savelieva, I.; Atar, D.; Hohnloser, S. H.; Hindricks, G.; Kirchhof, P.; Bax, J. J.; Baumgartner, H.; Ceconi, C.; Dean, V.; Deaton, C.; Fagard, R.; Funck-Brentano, C.; Hasdai, D.; Hoes, A.; Kirchhof, P.; Knuuti, J.; Kolh, P.; McDonagh, T.; Moulin, C.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Torbicki, A.; Vahanian, A.; et al. (2012). "2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation". European Heart Journal. 33 (21): 2719–47. doi:10.1093/eurheartj/ehs253. PMID 22922413.
  7. Shoeb, Marwa; Fang, Margaret C. (2013). "Assessing bleeding risk in patients taking anticoagulants". Journal of Thrombosis and Thrombolysis. 35 (3): 312–9. doi:10.1007/s11239-013-0899-7. PMC 3888359. PMID 23479259.
  8. Elliott, Meghan J.; Zimmerman, Deborah; Holden, Rachel M. (2007). "Warfarin Anticoagulation in Hemodialysis Patients: A Systematic Review of Bleeding Rates". American Journal of Kidney Diseases. 50 (3): 433–40. doi:10.1053/j.ajkd.2007.06.017. PMID 17720522.
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