02 / Bleeding Risk

HAS-BLED

Major Bleeding Risk on Anticoagulation

Pisters R, et al. Chest 2010;138(5):1093–1100

Score 0 / 9

HHypertension (uncontrolled)+1

Persistent systolic BP > 160 mmHg.

AAbnormal renal function+1

Dialysis, renal transplant, or serum creatinine ≥ 2.26 mg/dL (200 μmol/L).

AAbnormal liver function+1

Cirrhosis, or bilirubin > 2× ULN plus (AST/ALT/ALP > 3× ULN).

SStroke history+1

Prior ischemic or hemorrhagic stroke.

BBleeding history or predisposition+1

Prior major bleeding, bleeding diathesis, or anemia.

LLabile INR+1

Time in therapeutic range < 60% on warfarin (not applicable for DOAC users).

EElderly (> 65 years)+1

Age over 65.

DDrugs predisposing to bleeding+1

Concomitant antiplatelet agents (aspirin, clopidogrel, etc.) or NSAIDs.

DAlcohol excess+1

≥ 8 alcoholic drinks per week.

Low risk

0 / 9 points

Clinical Interpretation

1-Year Major Bleeding Risk

A HAS-BLED ≥ 3 is not an absolute contraindication to anticoagulation. It signals elevated bleeding risk and a need to address modifiable risk factors (BP control, discontinuing NSAIDs, reducing alcohol intake) and to monitor more closely.
Interpret alongside the CHA₂DS₂-VASc score — when stroke risk outweighs bleeding risk, anticoagulation is generally still recommended.
The 2024 ESC AF guideline emphasizes individual risk-factor assessment and periodic reassessment over rigid application of the HAS-BLED score.
In patients on a DOAC, the L (labile INR) item does not apply and should be scored 0.