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'''Editors-in-Chief:''' Gregory Lip, MD [mailto:gregory.lip@gmail.com] and [[C. Michael Gibson]], M.S., M.D. [mailto:charlesmichaelgibson@gmail.com]
'''Editors-in-Chief:''' Gregory Lip, MD [mailto:gregory.lip@gmail.com] and [[C. Michael Gibson]], M.S., M.D. [mailto:charlesmichaelgibson@gmail.com] {{AE}}{{SSH}}


==Overview==
==Overview==
A [[therapeutic bleeding risk]] stratification score for those on oral anticoagulants in [[atrial fibrillation]]<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=20299623 Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey. Chest. 2010 Mar 18.]<small>(Epub ahead of print) </small><small>([http://dx.doi.org/10.1378/chest.10-0134 Link to article] &ndash; subscription may be required.)</small></ref>. It is matched to the [[CHA2DS2-VASc score]] used for stroke risk stratification. In a recent article validating the score, [[diabetes]] and [[left ventricular dysfunction]] were identified as additional risk factors for bleeding<ref name="pmid21111555">{{cite journal |author=Lip GY, Frison L, Halperin JL, Lane DA |title=Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation The HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) Score |journal=[[Journal of the American College of Cardiology]] |volume=57 |issue=2 |pages=173–80 |year=2011 |month=January |pmid=21111555 |doi=10.1016/j.jacc.2010.09.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)04337-8 |issn= |accessdate=2011-01-24}}</ref>.
The HAS-BLED score is a therapeutic bleeding risk stratification score for those on oral anticoagulants in [[atrial fibrillation]]<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=20299623 Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey. Chest. 2010 Mar 18.]<small>(Epub ahead of print) </small><small>([http://dx.doi.org/10.1378/chest.10-0134 Link to article] &ndash; subscription may be required.)</small></ref>. It is recommended by the new European Society of Cardiology guidelines and the Canadian guidelines on atrial fibrillation management.<ref name=":0">Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429.  </ref><ref name=":1">Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M; CCS Atrial Fibrillation Guidelines Committee. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol. 2011 Jan-Feb;27(1):74-90. </ref> This score would help as a potential practical tool in clinical decision making, rather than 'guessing' the bleeding risk. Also, the HAS-BLED score makes clinicians think about addressing any correctable bleeding risk factors (eg. uncontrolled hypertension, coadministration of NSAIDs or aspirin, etc). It is matched to the [[CHA2DS2-VASc score]] used for stroke risk stratification. In a recent article validating the score, [[diabetes]] and [[left ventricular dysfunction]] were identified as additional risk factors for bleeding.<ref name="pmid21111555">{{cite journal |author=Lip GY, Frison L, Halperin JL, Lane DA |title=Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation The HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) Score |journal=[[Journal of the American College of Cardiology]] |volume=57 |issue=2 |pages=173–80 |year=2011 |month=January |pmid=21111555 |doi=10.1016/j.jacc.2010.09.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)04337-8 |issn= |accessdate=2011-01-24}}</ref>


== HAS-BLED score Calculator ==
== HAS-BLED Score Calculator ==


=== Calculation of the HAS-BLED Score for Bleeding ===
=== Calculation of the HAS-BLED Score for Bleeding ===
{| class="wikitable"
Please check the boxes that apply to your patient to calculate the HAS-BLED score for bleeding:
|+ HAS-BLED score for bleeding risk on oral anticoagulation in atrial fibrillation
 
|-----
{{#Widget:HASBLEDscore}}
! style="background:#669966; color:#ffffff;" |Feature
! style="background:#6699cc; color:#ffffff;" |Score if present
|-----
| style="background:#effeef;" align="left" |Hypertension (Systolic &ge; 160mmHg)
| style="background:#f9f9ff;" align="left" |1
|-----
| style="background:#dff9d9;" align="left" |Abnormal renal function
| style="background:#e9f9f9;" align="left" |1
|-----
| style="background:#effeef;" align="left" |Abnormal liver function
| style="background:#f9f9ff;" align="left" |1
|-----
| style="background:#dff9d9;" align="left" |Age &ge; 65 years
| style="background:#e9f9f9;" align="left" |1
|-----
| style="background:#effeef;" align="left" |Stroke in past
| style="background:#f9f9ff;" align="left" |1
|-----
| style="background:#dff9d9;" align="left" |Bleeding
| style="background:#e9f9f9;" align="left" |1
|-----
| style="background:#effeef;" align="left" |Labile INRs
| style="background:#f9f9ff;" align="left" |1
|-----
| style="background:#dff9d9;" align="left" |Taking other drugs as well
| style="background:#e9f9f9;" align="left" |1
|-----
| style="background:#effeef;" align="left" |Alcohol intake at same time
| style="background:#f9f9ff;" align="left" |1
|-----
|}


===Interpretation of the HAS-BLED Score for Bleeding===
===Interpretation of the HAS-BLED Score for Bleeding===
A score of 3 or more indicates an increased one year bleed risk on anticoagulation which would be sufficient to justify caution or more frequent evaluation.  The risk is the risk of an intracranial bleed, bleeding requiring hospitalization or a hemoglobin drop <u>></u> 2g/L or a bleeding episode that requires transfusion.
* 0 Score: 1.13 bleeds per 100 patient-years
 
* 1 Score: 1.02 bleeds per 100 patient-years
The HAS-BLED score is recommended within the new European Society of Cardiology guidelines  <ref>Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429.  </ref> and the Canadian guidelines  <ref>Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M; CCS Atrial Fibrillation Guidelines Committee. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol. 2011 Jan-Feb;27(1):74-90. </ref> on atrial fibrillation management.  This score would help as a potential practical tool in clinical decision making, rather than 'guessing' the bleeding risk. Also, the HAS-BLED score makes clinicians think about addressing any correctable bleeding risk factors (eg. uncontrolled hypertension, coadministration of NSAIDs or aspirin, etc).
* 2 Score: 1.88 bleeds per 100 patient-years
* 3 Score: 3.74 bleeds per 100 patient-years
* 4 Score: 8.70 bleeds per 100 patient-years
* 5 to 9 Score: Insufficient data (high risk)


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


[[Category:Decision support tools]]
[[Category:Medicine]]
[[Category:Anticoagulation]]
[[Category:Hematology]]
[[Category:Clinical risk]]
[[Category:Scores]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Risk calculator]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]
[[Category:Calculator]]

Latest revision as of 21:58, 29 July 2020

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Editors-in-Chief: Gregory Lip, MD [1] and C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[3]

Overview

The HAS-BLED score is a therapeutic bleeding risk stratification score for those on oral anticoagulants in atrial fibrillation[1]. It is recommended by the new European Society of Cardiology guidelines and the Canadian guidelines on atrial fibrillation management.[2][3] This score would help as a potential practical tool in clinical decision making, rather than 'guessing' the bleeding risk. Also, the HAS-BLED score makes clinicians think about addressing any correctable bleeding risk factors (eg. uncontrolled hypertension, coadministration of NSAIDs or aspirin, etc). It is matched to the CHA2DS2-VASc score used for stroke risk stratification. In a recent article validating the score, diabetes and left ventricular dysfunction were identified as additional risk factors for bleeding.[4]

HAS-BLED Score Calculator

Calculation of the HAS-BLED Score for Bleeding

Please check the boxes that apply to your patient to calculate the HAS-BLED score for bleeding:

HAS-BLED Score
Variable Score
Age ≥ 65 years 1
Hypertension (Systolic Blood Pressure ≥ 160mmHg) 1
Abnormal renal function 1
Abnormal liver function 1
Stroke in past 1
Bleeding 1
Labile INRs 1
Taking other drugs as well 1
Alcohol intake at the same time 1
HAS-BLED Score:
Interpretation:

Interpretation of the HAS-BLED Score for Bleeding

  • 0 Score: 1.13 bleeds per 100 patient-years
  • 1 Score: 1.02 bleeds per 100 patient-years
  • 2 Score: 1.88 bleeds per 100 patient-years
  • 3 Score: 3.74 bleeds per 100 patient-years
  • 4 Score: 8.70 bleeds per 100 patient-years
  • 5 to 9 Score: Insufficient data (high risk)

References

  1. ↑ Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: The Euro Heart Survey. Chest. 2010 Mar 18.(Epub ahead of print) (Link to article – subscription may be required.)
  2. ↑ Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429.
  3. ↑ Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M; CCS Atrial Fibrillation Guidelines Committee. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol. 2011 Jan-Feb;27(1):74-90.
  4. ↑ Lip GY, Frison L, Halperin JL, Lane DA (2011). "Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation The HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) Score". Journal of the American College of Cardiology. 57 (2): 173–80. doi:10.1016/j.jacc.2010.09.024. PMID 21111555. Retrieved 2011-01-24. Unknown parameter |month= ignored (help)
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