Calculator · Cardiovascular

HAS-BLED

Major bleeding risk on anticoagulation for AF.

What it is for

Identifying modifiable bleeding risk factors — does NOT mean withholding anticoagulation. NICE NG196 recommends ORBIT in preference to HAS-BLED.

Use the working calculator

The working HAS-BLED calculator is on our calculators page. It is free and needs no account. Enter the values and it shows the result with the reading that goes with it.

Open the working calculatorAll calculatorsStart a 7-day free trial
The calculators are free. The trial opens the protocols and pathways they link to.

What you enter

The calculator asks for 9 items.

  • Hypertension uncontrolled (SBP > 160) (1 point)
  • Abnormal renal function (Cr > 200 / dialysis / transplant) (1 point)
  • Abnormal liver function (cirrhosis / bili > 2× / AST/ALT > 3×) (1 point)
  • Previous stroke (1 point)
  • Major bleeding history / predisposition (1 point)
  • Labile INR (warfarin TTR < 60%) (1 point)
  • Elderly (age > 65) (1 point)
  • Concomitant antiplatelet / NSAID (1 point)
  • Alcohol > 8 units / week (1 point)

How the result is read

The result is shown as HAS-BLED score, out of a maximum of 9.

The calculator reads each total as follows. Where a single answer changes the reading (for example sex, age or one extreme value), the working calculator says so.

TotalBandWhat the calculator says
0Low bleeding riskLowest bleeding-risk band; see NICE NG196. Pisters 2010: about 1 major bleed per 100 patient-years.
1 to 2Moderate riskIdentify and modify bleeding risk factors; see NICE NG196. Address: BP control, reduce alcohol, stop unnecessary NSAID/antiplatelet, monitor labs.
3 to 9High risk (score 3 or more)Modify all reversible bleeding risk factors and review more often; see NICE NG196. A high HAS-BLED is NOT a reason to withhold anticoagulation — it identifies what to fix (NICE NG196).

Sources

These are the sources the calculator cites. Check the current version before relying on a threshold.

Related

CHA₂DS₂-VAScStroke risk score in non-valvular AF.ORBITAlternative bleeding risk score for AF — may outperform HAS-BLED.QRISK3 (10-year CV risk)Predicts 10-year risk of MI / stroke. Proprietary algorithm. For education and practice only. For patient care, use the QRISK3 tool built into your clinical system (NICE NG238).ABCD₂ (TIA stroke risk)Risk of stroke after TIA within 7 days.QTc (Bazett)Heart-rate-corrected QT interval.All calculators60 clinical scores and tools

For qualified clinicians. A score supports a clinical decision and does not make it: check the inputs, read the cited source, and use the tools in your clinical system for patient care where one is provided.