HAS-BLED Score
Current HAS-BLED Score
0
0
HAS-BLED
—
Annual Risk
—
Category
—
HAS-BLED — Complete Bleeding Risk Guide
The HAS-BLED score was developed by Pisters et al. (2010) and is endorsed by the ESC 2020 guidelines. It remains the most widely used bleeding risk assessment tool in AF management. The score uses nine clinical variables to estimate the annual risk of clinically relevant major bleeding.
A critical principle: the HAS-BLED score exists to identify modifiable bleeding risk factors, not to justify withholding anticoagulation from patients with high stroke risk.
HAS-BLED Annual Bleeding Risk
| Score | Annual Bleeding Risk | Category |
|---|---|---|
| 0 | 0.9% | Low |
| 1 | 3.4% | Low-Moderate |
| 2 | 4.1% | Moderate |
| 3 | 5.8% | High |
| 4 | 8.9% | High |
| ≥5 | >9.1% | Very High |
Modifiable Factors
- Hypertension (H): Target BP <130/80 mmHg. Most important modifiable factor.
- Labile INR (L): TTR <60%? Switch to DOAC.
- Drugs (D): Review NSAIDs and antiplatelets. Add PPI protection.
- Alcohol (A): Counselling for excess consumption.
DOACs vs Warfarin
DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are associated with lower rates of intracranial haemorrhage compared to warfarin. Apixaban generally has the most favourable bleeding profile across major trials.
Frequently Asked Questions
⚠ Medical Disclaimer: HAS-BLED is a decision-support tool. Clinical decisions require CHA₂DS₂-VASc assessment and patient preference discussion.