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Before you score. HAS-BLED does not preclude anticoagulation. A high score identifies correctable risk factors, not a contraindication.
For clinical decision support only. Always integrate with full clinical assessment, local guidelines, and patient preferences.
The HAS-BLED score is a validated clinical tool that estimates the 1-year risk of major bleeding in patients with atrial fibrillation (AF) being considered for oral anticoagulation. Calculate HAS-BLED below:
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Clinicians at Connect2Care
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HAS-BLED scores guide anticoagulation in atrial fibrillation by flagging correctable bleeding risk factors. While some guidelines (ACCP, Canadian CCS) formally recommend its use, the 2024 ESC and 2023 ACC/AHA/ACCP/HRS guidelines no longer mandate any single bleeding score, noting poor discrimination and the risk of inappropriately withholding anticoagulation. Across all guidelines, one principle is universal: anticoagulation must not be stopped on the basis of bleeding risk factors alone.
A score of 3 or higher signals high bleeding risk and calls for more frequent clinical review after starting oral anticoagulation, not withdrawal of therapy. Clinicians act on the reversible components: control hypertension, stabilise a labile INR or switch to a DOAC, stop unnecessary NSAIDs or antiplatelet agents, and address alcohol excess (more than 8 drinks per week). A proton pump inhibitor should be considered in patients with high-risk upper gastrointestinal mucosal lesions on anticoagulation.
Because high bleeding risk often travels with high stroke risk, the score is read alongside CHA₂DS₂-VASc so that net clinical benefit drives the decision. Both risks should be reassessed regularly over time, not only at initiation. For non-valvular AF, DOACs are preferred over warfarin for their lower intracranial bleeding risk, though gastrointestinal bleeding risk varies by agent (apixaban and dabigatran carry a lower GI bleeding risk compared to rivaroxaban and edoxaban).