HAS-BLED Bleeding Risk Calculator

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Uncontrolled hypertension defined as systolic blood pressure above 160 mmHg. This is a modifiable risk factor.
Chronic dialysis, renal transplant, or serum creatinine above 2.26 mg/dL (200 micromol/L).
Chronic hepatic disease such as cirrhosis, or biochemical evidence of significant hepatic derangement (bilirubin more than twice the upper limit of normal, or AST/ALT/alkaline phosphatase more than three times the upper limit of normal).
Previous history of stroke, particularly lacunar or ischaemic stroke.
Prior major bleeding episode, or a predisposition to bleeding such as bleeding diathesis or anaemia.
Unstable or high INRs, or time in therapeutic range below 60% for patients on warfarin. Leave unchecked for patients on direct oral anticoagulants (DOACs).
Patient age above 65 years.
Concomitant use of antiplatelet agents (aspirin, clopidogrel, ticagrelor) or non-steroidal anti-inflammatory drugs. This is a modifiable risk factor.
Harmful alcohol consumption defined as 8 or more drinks per week. This is a modifiable risk factor.
HAS-BLED ScoreLow risk
0points

Total score from 0 (lowest risk) to 9 (highest risk)

Estimated annual bleeding risk0.01%
Modifiable risk factors present0factors
0 pts
Low<2Moderate2-3High3+

HAS-BLED score 0 - low bleeding risk (1.13 major bleeds per 100 patient-years in the derivation cohort).

  • No modifiable bleeding risk factors are currently checked. Non-modifiable factors (stroke history, age, organ dysfunction, prior bleeding) cannot be reversed but should prompt closer monitoring.
  • The low stroke-prevention benefit of anticoagulation must always be weighed against this bleeding risk using tools such as the CHA2DS2-VASc score. A high HAS-BLED score is a reason for caution and follow-up, not automatic contraindication.

Next stepContinue standard anticoagulation monitoring. Reassess the HAS-BLED score whenever the clinical picture changes (new medications, renal/hepatic deterioration, fall risk, alcohol history update).

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