HAS-BLED Bleeding Risk Score

Designed to assess the risk of major bleeding within a year in patients taking anticoagulants for atrial fibrillation (AF).

Clinical parameters

Hypertension (systolic >160 mmHg)

No0Yes+1

Required

Renal Disease (dialysis, transplant, or Cr >2.26 mg/dL)

No0Yes+1

Required

Liver Disease (cirrhosis or bilirubin >2× normal with elevated enzymes)

No0Yes+1

Required

Stroke History

No0Yes+1

Required

Prior Major Bleeding or Bleeding Predisposition

No0Yes+1

Required

Labile INR (unstable/high, TTR <60%)

No0Yes+1

Required

Age >65 years

No0Yes+1

Required

Medication Use Predisposing to Bleeding (aspirin, clopidogrel, NSAIDs)

No0Yes+1

Required

Alcohol Use (≥8 drinks/week)

No0Yes+1

Required

Score result

0 of 9 score components complete0 / 9

0 / 9

Complete all required parameters to calculate the score.

Still required

Hypertension (systolic >160 mmHg)
Renal Disease (dialysis, transplant, or Cr >2.26 mg/dL)
Liver Disease (cirrhosis or bilirubin >2× normal with elevated enzymes)
Stroke History
Prior Major Bleeding or Bleeding Predisposition
Labile INR (unstable/high, TTR <60%)
Age >65 years
Medication Use Predisposing to Bleeding (aspirin, clopidogrel, NSAIDs)
Alcohol Use (≥8 drinks/week)

Clinical context

The key pitfall is using HAS-BLED as an absolute reason to withhold anticoagulation. Instead, use it to identify and correct modifiable bleeding risks (for example, uncontrolled blood pressure, interacting drugs, excess alcohol, labile INR) while balancing thromboembolic risk.