Cardiology Risk score Moderate evidence Clinical review pending v1.0.0

HAS-BLED Bleeding Risk Score

What is the risk of major bleeding on anticoagulation, and which risk factors are modifiable?

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Fields marked * are required. Units can be changed per field.

Hypertension (uncontrolled, SBP > 160 mmHg) +1

Abnormal renal functionDialysis, transplant, or creatinine ≥ 2.26 mg/dL (200 µmol/L). +1

Abnormal liver functionCirrhosis, or bilirubin > 2× ULN with AST/ALT/ALP > 3× ULN. +1

Prior stroke +1

Prior major bleeding or predisposition to bleeding +1

Labile INRUnstable/high INRs or time in therapeutic range < 60% (only if on a VKA). +1

Elderly (age > 65 years) +1

Drugs predisposing to bleedingAntiplatelet agents or NSAIDs. +1

Alcohol use (≥ 8 drinks/week) +1

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About this tool

Nine-item score estimating 1-year major bleeding risk in anticoagulated patients with AF.

Intended use

Adults with atrial fibrillation on, or being considered for, oral anticoagulation.

Outcome

Major bleeding

Time horizon

1 year

Derivation population

Euro Heart Survey on AF.

Limitations

'Labile INR' only applies to vitamin K antagonists.
Should prompt correction of modifiable factors rather than withholding anticoagulation.

Clinical problems

Atrial fibrillation

Evidence

Evidence level

Moderate evidence

Externally validated, or an established physiological equation whose clinical thresholds rest on consensus; guideline support limited or mixed. Methodology

Guideline status

Used in European AF guidance to identify modifiable bleeding risk factors.

Evidence summaries for this tool are awaiting independent clinical review. Statistics are shown only where they could be attributed to a specific publication.

References

Original publicationPisters R, Lane DA, Nieuwlaat 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;138:1093-1100. Find on PubMed (opens in a new tab)

Version history

Version	Formula	Effective	Reviewer	Changes
v1.0.0	Pisters 2010	2026-10-03	—	Initial implementation with reference test vectors.

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Clinical decision support only. Interpret results in the context of the individual patient and current guidance; HumanPulse does not replace professional medical judgment.