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Cardiology Calculator

HAS-BLED Score Calculator

Bleeding risk assessment in atrial fibrillation patients on anticoagulation. ESC guideline validated.

HAS-BLED Criteria
Tick each criterion present. Each scores 1 point (max 9).
H — Hypertension (uncontrolled)
Systolic BP >160 mmHg
A — Abnormal Renal Function
Creatinine >200 μmol/L, dialysis, or renal transplant
A — Abnormal Liver Function
Cirrhosis, bilirubin >2×ULN, or AST/ALT >3×ULN
S — Stroke history
Previous ischaemic or haemorrhagic stroke
B — Bleeding history or predisposition
Prior major bleed, anaemia, or bleeding diathesis
L — Labile INR (if on warfarin)
TTR <60%, unstable/high INRs
E — Elderly (age ≥65)
Age 65 years or older
D — Drugs (antiplatelet / NSAIDs)
Concomitant aspirin, clopidogrel or NSAIDs
D — Alcohol (≥8 drinks/week)
Excess alcohol intake
⚠️ HAS-BLED identifies modifiable risk factors — not a reason to withhold anticoagulation.
HAS-BLED Result
HAS-BLED Score
0
Low Bleeding Risk

HAS-BLED Score: The Complete Clinical Guide

Bleeding risk in AF, modifiable risk factors, DOAC selection, and ESC guideline recommendations

What Is the HAS-BLED Score?

HAS-BLED is a validated bleeding risk score for patients with atrial fibrillation who are being considered for or are already on oral anticoagulation. Developed by Pisters et al. (2010) and validated in the Euro Heart Survey, it scores nine risk factors to estimate annual major bleeding risk. Critically, ESC 2020 guidelines emphasise it should be used to identify and correct modifiable bleeding risk factors — not to deny anticoagulation.

⚠️ Critical Point — ESC 2020
A high HAS-BLED score should NOT be used as a reason to withhold anticoagulation in AF patients who have CHA₂DS₂-VASc ≥2. The stroke risk in untreated AF still outweighs bleeding risk in most patients. Use HAS-BLED to identify and fix modifiable bleeding risks.

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References

  1. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in AF. Chest. 2010;138(5):1093-1100.
  2. Hindricks G, Potpara T, Dagres N, et al. ESC Guidelines for the diagnosis and management of AF. Eur Heart J. 2021;42(5):373-498.
  3. NICE NG196. Atrial fibrillation: diagnosis and management. Updated 2023.
  4. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in AF (ARISTOTLE). N Engl J Med. 2011;365:981-992.

⚠️ Medical Disclaimer: For educational and documentation purposes only. Anticoagulation decisions require full clinical assessment. MedDraftPro accepts no clinical liability.

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