HAS-BLED Bleeding Risk

Check each risk factor present in the patient to calculate the HAS-BLED score and estimate major bleeding risk on oral anticoagulation.

Hypertension (SBP > 160 mmHg)

Uncontrolled hypertension or treated but labile readings.

Abnormal renal function

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

Abnormal liver function

Cirrhosis or bilirubin >2× normal with AST/ALT/AP >3× normal.

History of stroke

Includes ischemic or hemorrhagic stroke.

History of bleeding

Major bleeding, anemia, or predisposition (e.g., diathesis).

Labile INR

Time in therapeutic range <60% while on warfarin.

Age > 65 years

Age ≥65 years adds one point.

Drugs predisposing to bleeding

Concomitant antiplatelets, NSAIDs, or other drugs increasing bleeding risk.

Alcohol excess

≥8 drinks/week (or alcohol abuse).

HAS-BLED score

Risk category

Low risk

Low bleeding risk. Continue appropriate anticoagulation with routine monitoring.

How to Use This Calculator

Evaluate each criterion

Review clinical history, labs, and medications to determine if each HAS-BLED item applies.

Count present risk factors

Each present risk factor counts as one point. Abnormal renal/liver function may each contribute separately.

Mitigate modifiable risks

Address blood pressure control, avoid interacting drugs, and stabilise INR to lower bleeding risk.

Formula

HAS-BLED assigns one point for each risk factor: Hypertension, Abnormal renal/liver function, Stroke, Bleeding history/predisposition, Labile INR, Elderly (>65), Drugs predisposing to bleeding, and Alcohol excess. Scores ≥3 indicate high bleeding risk.

Full Description

HAS-BLED was developed to estimate major bleeding risk in atrial fibrillation patients treated with anticoagulants. It guides clinicians to identify modifiable bleeding risks and intensify monitoring rather than withholding anticoagulation when stroke risk is high. Combine HAS-BLED with CHA₂DS₂-VASc to balance stroke and bleeding risks for shared decision-making.

Frequently Asked Questions

Should a high score preclude anticoagulation?

No. Instead, address modifiable factors and monitor closely. Stroke prevention benefits often outweigh bleeding risk.

How does HAS-BLED compare with ORBIT?

Both predict bleeding. HAS-BLED is simpler and remains guideline-endorsed; ORBIT may perform slightly better with DOACs.

Can renal and liver dysfunction each add points?

Yes. Add one point for renal and one for liver dysfunction if both are present.

Does controlled hypertension count?

Hypertension counts if systolic blood pressure remains >160 mmHg despite therapy.