How is the HAS-BLED score interpreted?

Score 0–2: Low to moderate bleeding risk. Score ≥ 3: High bleeding risk, warranting caution and more frequent monitoring. A high HAS-BLED score does NOT contraindicate anticoagulation — rather, it identifies patients who need closer follow-up and correction of modifiable risk factors.

Does a high HAS-BLED score mean you should stop anticoagulation?

No. A high HAS-BLED score should NOT be used as a reason to withhold anticoagulation, since the net clinical benefit of anticoagulation typically exceeds bleeding risk in patients with elevated CHA₂DS₂-VASc scores. Instead, address modifiable factors: control blood pressure, stabilize INR, reduce alcohol, and avoid concomitant antiplatelet agents when possible.

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HAS-BLED Bleeding Risk Score

Assess major bleeding risk in patients with atrial fibrillation on anticoagulation therapy. Score range: 0–9.

Criteria

Check all that apply:

Hypertension (uncontrolled SBP > 160 mmHg) Abnormal renal function (dialysis, transplant, Cr > 2.26 mg/dL) Abnormal liver function (cirrhosis, bilirubin > 2× ULN, AST/ALT/ALP > 3× ULN) Stroke history Bleeding history or predisposition Labile INR (unstable/high INRs, TTR < 60%) Elderly (age > 65) Drugs predisposing to bleeding (antiplatelets, NSAIDs) Drinking (alcohol excess, ≥ 8 drinks/week)

HAS-BLED Score

Low bleeding risk

0 points~1.13 bleeds per 100 patient-years

1 point~1.02 bleeds per 100 patient-years

2 points~1.88 bleeds per 100 patient-years

3 points~3.74 bleeds per 100 patient-years

4 points~8.70 bleeds per 100 patient-years

≥ 5 points~12.50 bleeds per 100 patient-years

⚠️ Important: A high HAS-BLED score is NOT a reason to withhold anticoagulation — it identifies modifiable risk factors and flags patients who need closer monitoring.

Disclaimer: For educational purposes only. Not a substitute for clinical judgment.

When to use

Use alongside CHA₂DS₂-VASc to balance stroke risk vs. bleeding risk when deciding on anticoagulation for atrial fibrillation. HAS-BLED is recommended by the ESC and CCS guidelines.

Clinical pearls

HAS-BLED ≥ 3 = high bleeding risk — does NOT mean "don't anticoagulate." It means identify and correct modifiable risk factors.
Modifiable factors: uncontrolled HTN, labile INR, concomitant antiplatelets/NSAIDs, alcohol excess.
Non-modifiable factors: age, stroke history, renal/liver disease.
If using DOACs instead of warfarin, the "L" (labile INR) criterion does not apply.

References

Pisters R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in AF patients. Chest. 2010;138(5):1093-1100.
Lip GYH, et al. Bleeding risk assessment and management in AF patients. Europace. 2011;13(5):723-746.

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About This Tool

What Is the HAS-BLED Score?

The HAS-BLED score is a validated clinical prediction tool for estimating the 1-year risk of major bleeding in patients with atrial fibrillation who are on anticoagulation therapy. It was developed from the Euro Heart Survey cohort and published by Pisters et al. in 2010. The acronym represents nine risk factors: Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile INR, Elderly, and Drugs/alcohol.

How to Interpret

A score ≥ 3 indicates high bleeding risk, but this should prompt risk factor modification rather than withholding anticoagulation. In most patients, the stroke risk from AF (assessed by CHA₂DS₂-VASc) outweighs the bleeding risk. The HAS-BLED score's primary value is identifying modifiable risk factors (e.g., switching from warfarin to a DOAC to eliminate labile INR, stopping unnecessary NSAIDs, controlling hypertension).

🔑 Clinical Pearls

A high HAS-BLED score should NEVER be the sole reason to withhold anticoagulation in AF.
Both stroke risk and bleeding risk increase with shared risk factors (age, HTN, stroke) — patients who bleed are often those who most benefit from anticoagulation.
DOACs have lower intracranial hemorrhage risk than warfarin — consider DOAC switch in high HAS-BLED patients on warfarin.
Recheck HAS-BLED periodically — risk factors change over time (e.g., after stopping an NSAID).

Key References

Pisters R, et al. A novel user-friendly score (HAS-BLED). Chest. 2010;138(5):1093-1100.
Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42(5):373-498.

Formula last verified: February 2026