Home / HAS-BLED Score

HAS-BLED Bleeding Risk Score

Estimate annual major bleeding risk in patients with atrial fibrillation on anticoagulation. A high score does not contraindicate anticoagulation — it flags modifiable risk factors.

Inputs

Hypertension (uncontrolled SBP > 160 mmHg)

Abnormal renal function (dialysis, transplant, Cr > 2.26 mg/dL)

Abnormal liver function (cirrhosis, bilirubin > 2× ULN, AST/ALT > 3× ULN)

Stroke (prior history)

Bleeding (prior major bleeding or predisposition)

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

Elderly (age > 65)

Drugs (antiplatelets, NSAIDs)

Drinking (≥ 8 drinks/week)

HAS-BLED Score (0–9)

Low bleeding risk

Estimated annual major bleed risk—

Interpretation—

Disclaimer: For educational purposes only. A high HAS-BLED score does not contraindicate anticoagulation. It identifies patients who need closer follow-up and modification of reversible risk factors.

Scoring (HAS-BLED)

Hypertension (uncontrolled): +1
Abnormal renal function: +1
Abnormal liver function: +1
Stroke history: +1
Bleeding history/predisposition: +1
Labile INR (TTR < 60%): +1
Elderly (> 65): +1
Drugs (antiplatelets/NSAIDs): +1
Drinking (alcohol excess): +1

Risk stratification

0: ~1.13% annual major bleeding
1: ~1.02%
2: ~1.88%
3: ~3.74%
4: ~8.70%
≥ 5: ~12.5% (insufficient data at higher scores)
≥ 3: "High risk" — warrants caution and addressing modifiable risk factors

Clinical pearls

HAS-BLED ≥ 3 does not mean "don't anticoagulate" — it means identify and address modifiable factors.
Modifiable factors: uncontrolled BP, labile INR, concomitant antiplatelets/NSAIDs, alcohol excess.
"Labile INR" is less relevant for DOACs; some clinicians assign 0 for this criterion if on DOAC.
Use alongside CHA₂DS₂-VASc for balanced stroke vs. bleeding risk assessment.

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;138(5):1093–1100.
ESC Guidelines for Atrial Fibrillation (2020).