Clinical factors that contribute to stroke risk and support anticoagulation in patients with atrial fibrillation are frequently risk factors for bleeding as well. The HAS-BLED Score was developed as a practical risk score to estimate the 1-year risk for major bleeding in patients with atrial fibrillation.
Study included 5,333 ambulatory and hospitalized patients with AF from both academic and non-academic hospitals in 35 member countries of the European Society for Cardiology.
- Patients were followed up at one year to determine survival and major adverse cardiovascular events, such as major bleeding.
- Major bleeding defined as any bleeding requiring hospitalization, and/or causing a decrease in hemoglobin level >2 g/dL, and/or requiring blood transfusion that was not hemorrhagic stroke.
- Researchers performed a retrospective, univariate analysis to find potential bleeding risk factors when comparing the groups with and without major bleeding at 1 year follow-up.
- Developed HAS-BLED score based on results of their analysis as well as known significant risk factors for major bleeding
- Results showed that the annual bleeding rate increased with increasing risk factors, with an overall major bleed rate of 1.5%.
Points to keep in mind:
- Study only provides risk percentages for given risk factor, does not categorize scores into low/medium/high risk
- HAS-BLED score, in the form that it was developed originally, still needs to be externally validated
- A modified version of the HAS-BLED score has been validated in a Japanese population. This study used different standards for hypertension and labile INR and did not include alcohol consumption.
- A study comparing HEMORR₂HAGES, ATRIA and HAS-BLED showed superior performance of the HAS-BLED score compared to the other two.
