Cardiovascular
HAS-BLED Bleeding Risk Score Estimate major bleeding risk in AF patients on anticoagulation.
When to use: Use HAS-BLED alongside CHA₂DS₂-VASc when considering anticoagulation in AF. A high HAS-BLED score (≥3) should prompt correction of modifiable bleeding risk factors (BP control, stop NSAIDs, reduce alcohol) rather than withholding anticoagulation, as stroke risk typically outweighs bleeding risk at high CHA₂DS₂-VASc scores.
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Formula HAS-BLED = H(1) + A(1) + S(1) + B(1) + L(1) + E(1) + D(1) + Drugs(1) + Alcohol(1)
H=Hypertension, A=Abnormal renal/liver, S=Stroke, B=Bleeding, L=Labile INR, E=Elderly, D=Drugs/alcohol
Max score = 9
Key Points for NEET PG
Mnemonic: H-A-S-B-L-E-D: Hypertension, Abnormal renal/liver function, Stroke history, Bleeding history/predisposition, Labile INR, Elderly (>65), Drugs/alcohol. Score ≥3 = high risk of major bleeding (~3.7% per year). Address modifiable factors; do NOT automatically withhold anticoagulation. Labile INR (TTR <60%) is a key modifiable factor; switching to a DOAC eliminates the need for INR monitoring. HAS-BLED is validated for warfarin; it underestimates bleeding risk with DOACs (use ORBIT score for DOACs in some guidelines). Antiplatelet drugs (aspirin, clopidogrel) + anticoagulation significantly increases bleeding risk; avoid dual therapy unless mandatory (e.g., recent ACS/stenting, use for shortest duration). References
Pisters R et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation · Chest (2010)
ESC Guidelines for the diagnosis and management of atrial fibrillation 2020 · Eur Heart J (2021)
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