Skip to content
Hakeemly
ع

HAS-BLED Bleeding Risk Score

One-year major bleeding risk in patients with atrial fibrillation on anticoagulation.

For healthcare professionalsCardiology scoresv1.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

Uncontrolled hypertension (systolic over 160 mmHg)
Abnormal renal function (dialysis, transplant, creatinine ≥ 2.26 mg/dL / 200 µmol/L)
Abnormal liver function (cirrhosis, or bilirubin > 2× ULN with AST/ALT/ALP > 3× ULN)
Previous stroke
Previous major bleeding or bleeding predisposition
Labile INR (time in therapeutic range under 60%)
Age over 65
Antiplatelet drugs or NSAIDs
Alcohol use (8 or more drinks a week)

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

HAS-BLED (Pisters 2010)

1 point each: H, A (renal), A (liver), S, B, L, E, D (drugs), D (alcohol)

A high score is a prompt to correct modifiable bleeding risks, not by itself a reason to withhold anticoagulation.

Who it is for
Adults with atrial fibrillation.
Version
1.0.1

How this calculator works

Where the formula comes from

  • HAS-BLED was developed by Pisters and colleagues in 2010 from 3,978 patients with atrial fibrillation in the Euro Heart Survey with complete one-year follow-up, to estimate the one-year risk of major bleeding.[1]
  • Fifty-three major bleeds (1.5%) occurred during the year; the risk factors from the derivation cohort had a C-statistic of 0.72.[1]

The inputs

  • One point each for uncontrolled systolic hypertension (over 160 mmHg), abnormal renal function, abnormal liver function, previous stroke, bleeding history or predisposition, labile INR, age over 65, antiplatelet or NSAID use, and alcohol excess; renal and liver abnormalities each score separately (maximum 9).[1][2]
  • Abnormal renal function includes dialysis, kidney transplantation or serum creatinine of 200 µmol/L or more. Abnormal liver function includes cirrhosis, or bilirubin over twice the upper limit of normal together with AST, ALT or ALP over three times the upper limit of normal.[2]

Versions and alternatives

  • Other bleeding risk scores for atrial fibrillation include ORBIT, which was developed in 2015 as a simple bedside score.[3]

Where accuracy falls (published evidence)

  • The labile INR item only applies to patients taking a vitamin K antagonist such as warfarin.[2]

What guidelines say

  • ESC 2024 advises against using bleeding risk scores alone to decide whether to start or withhold oral anticoagulation; modifiable bleeding risk factors should be identified and managed.[2]
  • A high bleeding risk score is used to prompt more frequent clinical review and follow-up rather than as a stand-alone decision rule.[2]

Sources

  1. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–1100. doi:10.1378/chest.10-0134
  2. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314–3414. doi:10.1093/eurheartj/ehae176
  3. O'Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36(46):3258–3264. doi:10.1093/eurheartj/ehv476

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate HAS-BLED

Inputs

Uncontrolled hypertension (systolic over 160 mmHg)
Yes
Abnormal renal function (dialysis, transplant, creatinine ≥ 2.26 mg/dL / 200 µmol/L)
No
Abnormal liver function (cirrhosis, or bilirubin > 2× ULN with AST/ALT/ALP > 3× ULN)
No
Previous stroke
No
Previous major bleeding or bleeding predisposition
Yes
Labile INR (time in therapeutic range under 60%)
No
Age over 65
Yes
Antiplatelet drugs or NSAIDs
No
Alcohol use (8 or more drinks a week)
No

Result

HAS-BLED
3 of 9

3 or more: high bleeding risk — address modifiable risk factors and review more often

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • 'Labile INR' applies only to vitamin K antagonists.

References

  1. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–1100. doi:10.1378/chest.10-0134
  2. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314–3414. doi:10.1093/eurheartj/ehae176

You may also find useful