Anticoagulation for atrial fibrillation – HAS-BLED

Decision

Assess bleeding risk of AF patients

Population

AF patients in need antithrombotic therapy for stroke prevention.

Components

Hypertension: 1 point for uncontrolled high blood pressure, with a systolic (top number) reading of 160 or higher

Abnormal kidney and/or liver function: 1 point for impaired kidney or liver function, and 2 points for both

Stroke: 1 point for previous history of stroke, especially deep brain (lacunar) stroke

Bleeding: 1 point for previous history of bleeding, anemia or having predisposition to bleeding

Labile INR: 1 point for unstable or high INRs, or poor time (less than 60%) in the therapeutic time range

Elderly: 1 point for age 65 or older

Drugs and/or alcohol: 1 point for taking antiplatelet drugs (like aspirin or Plavix) and 1 point for consuming 8 or more alcoholic drinks per week, or 2 points for both

Score

The ‘trade off’ in terms of the benefits and risks of Oral Anticoagulation (OAC) using the CHADS2 index and HAS-BLED score demonstrates that in the vast majority of AF patients who require OAC (CHADS2 index ≥ 2) the risk of bleeding outweighs the potential benefit of OAC if the HAS-BLED bleed score exceeds the individual CHADS2 index.”

Reference

A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey, Chest, the official publication of the American College of Chest Physicians, prepublished online February 26, 2010