HAS-BLED Score Calculator

HAS-BLED is a clinical score designed to flag bleeding-risk factors in people with atrial fibrillation. This page adds one point for each selected factor: uncontrolled hypertension, abnormal renal function, abnormal liver function, prior stroke, bleeding history or predisposition, labile INR, age 65 or older, relevant drugs and alcohol use. Renal and liver factors can each score, as can drugs and alcohol, so the total ranges from 0 to 9.

The score is meant to structure review and draw attention to modifiable factors. It does not predict with certainty whether an individual will bleed, diagnose any condition, or decide whether anticoagulation should be started, stopped or changed. Some items require clinical records and precise definitions. Anyone using anticoagulants should discuss concerns with the prescribing team and should not alter treatment from this result.

Choose yes only when the published criterion is met. Hypertension refers to systolic blood pressure above 160 mmHg. Abnormal kidney and liver function have clinical definitions involving dialysis, transplant, laboratory values or established disease. Labile INR concerns unstable or poorly controlled INR/time in therapeutic range in a person using a vitamin K antagonist. The drugs item includes medicines such as antiplatelets or nonsteroidal anti-inflammatory drugs; alcohol means the level defined by the score.

1. Use current records and medication details rather than guessing.
2. Review renal and liver criteria separately because each can add a point.
3. Review drugs and alcohol separately for the same reason.
4. Add one point for every yes response.
5. Use the total to organize professional review of risks that may be corrected or monitored.

A score of three or more has commonly been used to flag higher risk and the need for caution and regular review. It is not a direction to withhold anticoagulation. Stroke risk and bleeding risk are separate questions, and treatment decisions require benefits, harms, preferences and current guidelines.

A higher total means more listed bleeding-risk factors are present. A total of three or more is generally a prompt for caution and regular review, including attention to factors that may be modifiable. Examples can include blood-pressure control, avoidable interacting medicines, alcohol exposure and INR management when relevant. Age or a prior stroke cannot be modified, but may affect monitoring and discussion.

HAS-BLED was derived for patients with atrial fibrillation and should not be casually transferred to unrelated conditions. Its performance is imperfect, and it does not capture every contributor to bleeding. Frailty, falls, anemia, adherence, dosing, acute illness and other medicines may matter. For direct oral anticoagulants, the labile-INR item is generally not applicable in the same way as it is for warfarin.

Do not compare the points directly with a stroke-risk score or subtract one from the other. Clinicians assess thromboembolic benefit and bleeding risk together. Active major bleeding, vomiting blood, black stools, severe unexplained headache after injury or symptoms of shock require urgent care regardless of the calculated total.