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HAS-BLED Score for Major Bleeding Risk in Atrial Fibrillation

HAS-BLED estimates 1-year major bleeding risk in atrial fibrillation patients on anticoagulation (0–9 points). A score ≥3 indicates high bleeding risk, which calls for closer follow-up and correction of modifiable factors, not withholding anticoagulation.

  • Age (years)
  • Uncontrolled hypertension (SBP > 160 mmHg) (yes/no, +1)
  • Abnormal renal function (dialysis, transplant or Cr ≥ 2.26 mg/dL / 200 µmol/L) (yes/no, +1)
  • Abnormal liver function (cirrhosis, or bilirubin > 2× ULN with AST/ALT > 3× ULN) (yes/no, +1)
  • Prior stroke (yes/no, +1)
  • Prior major bleeding or predisposition to bleeding (e.g. anemia) (yes/no, +1)
  • Labile INR (time in therapeutic range < 60%) (yes/no, +1)
  • Antiplatelet or NSAID use (yes/no, +1)
  • Alcohol use (≥ 8 drinks/week) (yes/no, +1)
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Interpretation

ResultMeaning
0–2Low to moderate bleeding risk
≥ 3High risk: caution, regular review, address modifiable factors

Formula

H: uncontrolled hypertension (SBP > 160) 1 · A: abnormal renal 1, abnormal liver 1 · S: stroke 1 · B: bleeding history/predisposition 1 · L: labile INR 1 · E: elderly (> 65) 1 · D: antiplatelet/NSAID 1, alcohol ≥ 8 drinks/week 1

Clinical pearls

  • A high HAS-BLED is not by itself a reason to withhold anticoagulation; stroke risk usually outweighs bleeding risk.
  • Focus on the modifiable items: blood pressure, labile INR (consider a DOAC), concomitant antiplatelets/NSAIDs and alcohol.
  • The labile INR item applies only to patients on a vitamin K antagonist.

Examples

has-bled 72 year old with uncontrolled htn, prior stroke, on aspirinbleeding risk for af patient 80F on warfarin with labile inr and ckd on dialysishasbled 60M alcohol 10 drinks/week

FAQ

What HAS-BLED score is high risk?

A score of 3 or more indicates high risk of major bleeding and warrants caution and regular review.

Should I stop anticoagulation if HAS-BLED is high?

Generally no. Guidelines use HAS-BLED to flag modifiable bleeding risk factors and closer follow-up, not to deny anticoagulation.

Evidence

  1. 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;138:1093–100.

Cardiology · Reviewed 2026-10-14 · Methodology