HAS-BLED Score

Estimates the 1-year risk of major bleeding for patients on anticoagulation for atrial fibrillation. Crucially, a high score is not a reason to withhold anticoagulation, but rather a prompt to identify and correct modifiable bleeding risk factors.

Hypertension +1

Uncontrolled, systolic > 160 mmHg

Abnormal Renal/Liver Function

Renal +1

Dialysis, transplant, or Cr > 200 µmol/L

Liver +1

Cirrhosis, or bilirubin > 2x normal with AST/ALT > 3x normal

Stroke +1

Previous history, particularly lacunar

Bleeding History or Predisposition +1

Prior major bleed or anaemia

Labile INRs +1

Time in therapeutic range (TTR) < 60% (Only applies if on VKA/Warfarin)

Elderly +1

Age > 65 years

Drugs / Alcohol

Drugs +1

Concomitant antiplatelets (e.g., Aspirin, Clopidogrel) or NSAIDs

Alcohol +1

≥ 8 drinks per week

Total Score

/ 9

Clinical Application

Score 0-2: Low to moderate risk of bleeding (~1-2% per year).
Score ≥ 3: High risk of bleeding. Warrants more frequent review.

Modifiable Risk Factors:

Hypertension (Control BP to < 160)
Labile INRs (Switch to DOAC if appropriate)
Concomitant drugs (Deprescribe NSAIDs/unnecessary antiplatelets)
Alcohol intake (Counselling)

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