Table 3.4-4. HAS-BLED bleedinga risk score in patients with atrial fibrillation

Clinical characteristic

Points

Hypertensionb

1

Abnormal renalc and liver functiond

1 or 2

Stroke

1

Bleedinge

1

Labile INRsf

1

Elderly (age >65 years)

1

Drugsg or alcohol

1 or 2

Interpretation:

Score ≥3 points: High risk

a Severe bleeding, that is, intracranial, requiring hospitalization, associated with >2 g/dL decrease in hemoglobin levels, or requiring transfusion.

b Systolic blood pressure >160 mm Hg.

c Chronic dialysis or renal transplantation or serum creatinine >200 micromol/L.

d Chronic liver disease (eg, cirrhosis) or biochemical evidence of significant liver derangement (eg, bilirubin >2 × ULN + ALT/AST/alkaline phosphatase >3 × ULN).

e History of bleeding, predisposition to bleeding, or both (eg, bleeding diathesis, anemia).

f Unstable/high INR or INR frequently (eg, >40% of test results) outside the therapeutic range.

g Concomitant treatment with antiplatelet agents or NSAIDs.

ALT, alanine aminotransferase; AST, aspartate aminotransferase; INR, international normalized ratio; NSAID, nonsteroidal anti-inflammatory drug; ULN, upper limit of normal