HAS-BLED bleeding risk assessment and oral anticoagulation
THE CONTEXT
HAS-BLED assesses bleeding risk in patients receiving oral anticoagulation. The passage also describes warfarin targets, reversal of anticoagulation and the limitations of aspirin for embolic stroke prevention.
HAS-BLED parameters: one point each
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Hypertension scores one point when current systolic blood pressure is greater than 160 mmHg.
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Abnormal liver function scores one point: cirrhosis, bilirubin greater than twice the upper reference limit, or transaminases greater than three times the upper reference limit.
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Abnormal renal function scores one point when creatinine exceeds 200 μmol/L (2.26 mg/dL).
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A history of stroke and a prior major bleeding event each score one point.
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Labile INR on warfarin scores one point.
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Age of at least 65 years scores one point.
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Use of an antiplatelet drug and high alcohol consumption each score one point.
Score interpretation
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The maximum HAS-BLED score is nine points.
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A score of at least three points requires close patient monitoring.
Warfarin and aspirin
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Warfarin can be adjusted to a target International Normalised Ratio (INR) of 2.0–3.0.
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If bleeding occurs during warfarin treatment, anticoagulation can be reversed with vitamin K or clotting factors.
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Aspirin should not be used for embolic stroke prevention in this setting because it has little or no effect on embolic stroke and carries significant bleeding risk.