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What Is HAS-BLED?

Medically Reviewed by James Beckerman, MD, FACC on February 28, 2020

There’s more to atrial fibrillation, or AFib, than an irregular heart rate. When your heartbeat is off kilter, blood can pool and clot in the upper chambers of your heart. A clot could block the flow of blood to your brain. This puts you at higher odds for a stroke.

To offset clots, doctor may prescribe anticoagulants, or blood thinners. They lower your stroke chances, but they raise the odds of life-threatening bleeding in your stomach, brain, and bladder.

To predict how high or low your chance of bleeding is, doctors use a scoring system called HAS-BLED.

Each letter of the name stands for something that raises your odds:

  • Hypertension (high blood pressure)
  • Abnormal kidney and liver function
  • Stroke
  • Bleeding
  • Labile international normalized ratios (Is your blood too thin?)
  • Elderly (65 or older)
  • Drugs (like aspirin) and alcohol (more than eight drinks a week)

Most factors are worth one point. You’ll rack up two point if you have either kidney and liver function problems, if you take certain medications, or drink alcohol.

What Do My Results Mean?

Your HAS-BLED score tells the doctor how to manage your care. This way, everyone who has AFib is not treated the same way.

If you have a score of three or higher, you don’t necessarily need to change your medication, but the doctor may want to see you and check your blood more often.

For some people, the doctor might want to talk about alternative medications or ways to reverse some of your risk factors, like lowering your blood pressure. It doesn’t mean you’ll stop taking blood thinners.

WebMD Medical Reference

Sources

SOURCES:

Mayo Clinic: “Atrial fibrillation.”

Journal of Atrial Fibrillation: “Validation of the HAS-BLED Tool in Atrial Fibrillation Patients Receiving Rivaroxaban.”

Dhanunjaya Lakkireddy, MD, chair, Electrophysiology Leadership Council, American College of Cardiology.

CHEST Journal: “A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk of Major Bleeding in Patients With Atrial Fibrillation.”

Journal of Applied Hematology: “Evaluation of bleeding risk in patients with renal impairment treated with Fondaparinux (Arixtra).”

American College of Cardiology: “HAS-BLED Tool – What Is the Real Risk of Bleeding in Anticoagulation?”

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