What does a HAS-BLED score of 3 or more mean?

A score of 3 or higher indicates high bleeding risk (~3.7 bleeds per 100 patient-years). This warrants caution and correction of modifiable risk factors rather than automatic discontinuation of anticoagulation, because the benefit of stroke prevention often still outweighs the bleeding risk.

Can I add points for both abnormal renal and abnormal liver function?

Yes. Abnormal renal function (creatinine > 200 µmol/L, dialysis, or transplant) and abnormal liver function (cirrhosis or bilirubin > 2x normal with elevated enzymes) each add 1 point, for a maximum of 2 points from the "A" criterion.

What counts as labile INR?

A time in therapeutic range (TTR) below 60%, or INR values that fluctuate widely despite adherence to warfarin therapy, counts as a labile INR. This criterion is not applicable to patients on NOACs (novel oral anticoagulants).

Does a high HAS-BLED score mean anticoagulation should be stopped?

No. Clinical guidelines recommend addressing modifiable risk factors (uncontrolled hypertension, labile INR, concurrent antiplatelet or NSAID use, excessive alcohol). Stopping anticoagulation without strong cause may increase stroke risk significantly.

How does HAS-BLED compare to CHA2DS2-VASc?

CHA2DS2-VASc estimates stroke risk, while HAS-BLED estimates bleeding risk. Both scores are used together: if stroke risk is high and bleeding risk is manageable, anticoagulation is generally recommended.

Is HAS-BLED validated for NOAC users?

The score was originally validated for warfarin users; however, it is widely applied to NOAC users as well because the non-INR risk factors remain clinically relevant. The labile-INR criterion is typically scored 0 for NOAC patients.

HAS-BLED Bleeding Risk Score

Name: HAS-BLED Bleeding Risk Score
Availability: InStock
Author: Nham Vu

Enter patient data to calculate the HAS-BLED score and estimate major bleeding risk during anticoagulation therapy.

HAS-BLED Criteria

Check each criterion that applies to the patient. Hover the info icon for definitions.

H — Hypertension +1

Uncontrolled systolic blood pressure >160 mmHg

A — Abnormal Renal Function +1

Dialysis, transplant, or creatinine >200 µmol/L (2.26 mg/dL)

A — Abnormal Liver Function +1

Cirrhosis, or bilirubin >2× normal with elevated AST/ALT/ALP >3× normal

S — Stroke History +1

Prior stroke or TIA

B — Bleeding History or Predisposition +1

Prior major bleed, anemia, or bleeding tendency

L — Labile INR +1

Unstable/high INR or TTR <60% on warfarin (score 0 for NOAC patients)

E — Elderly (Age >65) +1

Age older than 65 years

D — Antiplatelet or NSAID Use +1

Concurrent antiplatelet agents (aspirin, clopidogrel) or NSAIDs

D — Alcohol Use +1

Excessive alcohol intake (≥8 drinks per week)

Select criteria on the left and click Calculate Score.

Summary

Enter patient data to calculate the HAS-BLED score and estimate major bleeding risk during anticoagulation therapy.

How it works

Select whether each of the 7 HAS-BLED criteria applies to the patient.
Each criterion present adds 1 point; abnormal renal AND liver function can each add 1 point (max 2 for that criterion).
The total score ranges from 0 to 9.
Scores of 0-1 indicate low risk, 2 indicates moderate risk, and 3 or above indicates high risk.
High risk does not automatically mean anticoagulation should be stopped — it signals a need to correct reversible risk factors.

Use cases

Assessing bleeding risk before starting anticoagulation in atrial fibrillation patients.
Monitoring patients already on warfarin, dabigatran, rivaroxaban, or apixaban.
Identifying modifiable bleeding risk factors to reduce a patient's score.
Balancing stroke prevention (CHA2DS2-VASc) against bleeding risk.
Clinical decision support in cardiology, internal medicine, and primary care.
Patient education about their individual bleeding risk.

Frequently Asked Questions

Last updated: 2026-06-09 · Reviewed by Nham Vu