Cardiology
The HAS-BLED is a clinical score used to structure the assessment of bleeding risk in patients with atrial fibrillation who are receiving anticoagulation. Its primary value is in identifying patients who require closer monitoring and, above all, potentially modifiable risk factors. A high score should not be used in isolation to withhold or discontinue an indicated anticoagulant.
Number of questions
7 components, 9 criteria
Approximate duration
1 to 2 minutes
Population
adults with atrial fibrillation / anticoagulation
Modality
clinician score
QuestionnaireHAS-BLED
CLINICIAN SCORE
The healthcare professional assesses nine criteria based on medical history, treatments, and laboratory data; each criterion met is worth 1 point (letters A and D can be worth 2 points), for a total score of 0 to 9.
Are you patient?
The HAS-BLED score requires knowledge of medical history, current treatments, and sometimes lab results. It should be calculated and interpreted with a healthcare professional.
Terms of contract
Document the version used and its operational definitions: notably blood pressure, renal/hepatic impairment, labile INR, and alcohol consumption. Risk factors change over time. Adopted operational definitions: hypertension with SBP > 160 mmHg; renal disease: dialysis, renal transplantation, or serum creatinine > 200 µmol/L; liver disease: cirrhosis or bilirubin > 2x the upper limit of normal associated with AST/ALT/alkaline phosphatase > 3x the upper limit of normal; labile INR on VKAs: TTR < 60%; medication: antiplatelets or NSAIDs; alcohol: more than 8 units per week according to the historical HAS-BLED convention, to be documented without arbitrarily equating units between countries.
Score interpretationHAS-BLED
Sum of the criteria present, 1 point each (letters A and D can count for up to 2 points). Score from 0 to 9.
Total score
First reading
0
to
2
Score below the threshold of 3, which typically indicates an increased risk of bleeding.
3
to
9
A score ≥ 3 conventionally indicates an increased bleeding risk.
≥ 3: increased bleeding risk, closer monitoring, and active search for modifiable factors.
It does not perfectly predict bleeding, depends on precise definitions, and must be reassessed. It does not replace clinical judgment.
Frequently asked questions
What is HAS-BLED used for?
Does a high score mean that anticoagulants should be stopped?
What are its limitations?
Sources and references
Pisters R et al.
Pisters R et al., Chest, 2010; integration into contemporary AF guidelines
In practice
Full name
Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol
Method
clinician score
Language
Not applicable (clinical score)
Authors
Pisters R et al.
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