Hematology and Oncology Book

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HAS-BLED Score

Aka: HAS-BLED Score
  1. See Also
    1. Outpatient Bleeding Risk Index
    2. Atrial Fibrillation Anticoagulation
    3. CHAD Score
  2. Indications
    1. Atrial Fibrillation Anticoagulation (used in combination with CHAD Score)
  3. Criteria: 1 point for each
    1. Hypertension
      1. Uncontrolled with systolic Blood Pressure >160 mmHg
    2. Renal dysfunction
      1. Serum Creatinine >2.3 mg/dl
    3. Liver dysfunction
      1. Bilirubin >2x normal or
      2. Alkaline Phosphatase >3x normal
      3. Liver transaminases (e.g. AST, ALT) >3x normal
    4. Stroke history
    5. Bleeding history
      1. Major bleeding or predisposition
      2. Bleeding that required hospitalization or
      3. Bleeding with serious consequences (e.g. Intracranial Hemorrhage) or
      4. Hemoglobin decrease of >2 g/dl or
      5. Bleeding that required transfusion
    6. Labile INRs
      1. History of over-Anticoagulation
    7. Elderly
      1. Age over 65 years old
    8. Drugs (up to 1 point for meds and 1 point for Alcohol)
      1. Other Anticoagulants
      2. Anti-platelet agents
      3. NSAIDs
      4. Alcohol >8 drinks weekly
  4. Interpretation
    1. Maximum total score: 9
    2. Risk of major bleeding in one year
      1. Score 0 points: Major bleeding risk 1% per year
      2. Score 1 points: Major bleeding risk 3.4% per year
      3. Score 2 points: Major bleeding risk 4.1% per year
      4. Score 3 points: Major bleeding risk 5.8% per year
      5. Score 4 points: Major bleeding risk 8.9% per year
      6. Score 5 points: Major bleeding risk 9.1% per year
      7. Score >5 points: Major bleeding risk 12-15% per year
  5. References
    1. Gallego (2012) Circ Arrhythm Electrophysiol 5(2):312-8 [PubMed]
    2. Lip (2011) J Am Coll Cardiol 57(2):173-80 [PubMed]
    3. Pisters (2010) Chest 138(5):1093-100 [PubMed]

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