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HAS-BLED Score for Bleeding Risk on Anticoagulation

Bleeding risk on anticoagulation for AF — a high score is a to-do list, not a veto.

Low bleeding risk
HAS-BLED 0–1 · ~1.0–1.1 major bleeds per 100 patient-years
0pts
Modifiable — the reason to score this at all
Hypertension — UNCONTROLLED, SBP >160 mmHg
Labile INR — TTR <60% (warfarin only)
Drugs predisposing to bleeding — antiplatelets or NSAIDs
Alcohol use — ≥8 drinks per week
Not modifiable — which is why the ones above matter
Abnormal renal function — dialysis, transplant, or Cr >2.26 mg/dL (200 µmol/L)
Abnormal liver function — cirrhosis, bilirubin >2× ULN, or AST/ALT/ALP >3× ULN
Stroke history
Prior major bleeding or predisposition (previous major bleed, anaemia, thrombocytopenia)
Elderly — age >65 years
Derived from the Euro Heart Survey (3,978 patients) · A high HAS-BLED is a to-do list, not a veto — it identifies modifiable risk (BP control, labile INR, NSAIDs/antiplatelets, alcohol), it does not contraindicate anticoagulation. Net benefit of anticoagulation holds at CHA₂DS₂-VASc ≥2 even with HAS-BLED ≥3.