HAS-BLED Score
Estimates 1-year risk of major bleeding in anticoagulated patients with AF.
How to use & interpret
HAS-BLED estimates 1-year risk of major bleeding in patients with atrial fibrillation being considered for, or taking, anticoagulation. Its main value is flagging and addressing modifiable bleeding risk factors (uncontrolled hypertension, labile INR, concurrent antiplatelets/NSAIDs, harmful alcohol use) — not to withhold anticoagulation.
A score ≥3 indicates higher bleeding risk warranting caution and closer review, but a high HAS-BLED on its own should rarely override a clear anticoagulation indication, because stroke risk usually outweighs bleeding risk. Use it alongside CHA₂DS₂-VASc, not instead of it.
Score interpretation
Score 0–2: Low 1-year bleeding risk (~1–2%). Anticoagulation benefit likely outweighs risk.
→ Anticoagulation is appropriate. Address modifiable risk factors.
Score ≥3: High bleeding risk (~3.7–12.5%/year). Does NOT mean anticoagulation is contraindicated.
→ Correct modifiable risk factors. Clinical judgement required — weigh against stroke risk (CHA₂DS₂-VASc). Regular review.
Interpretation bands for the HAS-BLED. Apply clinical judgement and local guidance.
Frequently asked questions
Does a high HAS-BLED mean I should stop anticoagulation?
Usually no. It identifies and prompts correction of modifiable bleeding risks and flags patients needing closer monitoring. Stroke risk typically still favours anticoagulation.
References
- Pisters R et al. A Novel User-Friendly Score (HAS-BLED). Chest. 2010.
Related
Curated clinical cross-links plus same-class fallbacks.
- ApixabanRecommendedDirect oral anticoagulant (DOAC) — Factor Xa inhibitor
- Edoxaban (AF Stroke Prevention / VTE)RecommendedDirect Factor Xa Inhibitor (DOAC)
- Dabigatran etexilateRecommendedDirect thrombin (factor IIa) inhibitor (DOAC)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.