DISCLAIMER
The assessment tools contained in this Application ("Assessment Tools") are intended only to
be an informational tool for clinicians who have been allowed access to the Application by
Bl. The Assessment Tools are not intended to provide general or specific medical advice. The
Assessment Tools do not take into account other considerations including, but not limited
to, drug interactions, contraindications and patient history, and other risk factors.
Therefore, the Application and Assessment Tools should be used as a general guide only and
any specific advice provided by clinicians should be based on a professional review and
consideration of each patient.
An assessment of bleeding risk should include commonly encountered risk factors that can be
actively managed to reduce bleeding risk.1
The 2012 ESC guidelines recommend the use of the simple bleeding risk
assessment score, HAS-BLED, rather than more complicated scores.1
A HAS-BLED score of ≥3 indicates a high risk of bleeding; caution needs
to be exercised and patients regularly reviewed once anticoagulation is initiated.1
The 2012 ESC Guidelines state the HAS-BLED score alone should not be used
to exclude patients from anticoagulant therapy; rather it allows clinicians to make an
informed assessment of bleeding and, importantly, makes them consider the modifiable risk
factors for bleeding(e.g. uncontrolled blood pressure, concomitant use of aspirin/NSAIDs, labile
INRs, etc.)
that are correctable.
Definitions:
Hypertension:defined as systolic blood pressure> 160 mmHg
Abnormal kidney function: defined as the presence of chronic dialysis or renal transplantation
or serum
creatinine ≥ 200 mmol/L
Abnormal liver function: defined as chronic hepatic disease (e.g. cirrhosis)
or biochemical evidence of significant hepatic derangement(e.g.bilirubin >2 x upper limit of
normal, in association with
aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase >3 x upper limit
normal, etc.).
Bleeding: refers to previous bleeding history and/or predisposition to bleeding,
e.g. bleeding diathesis, anaemia. etc.
Labile INRs: refers to unstable/high INRs or poor time in therapeutic
range (e.g. <60%)
Drugs/alcohol use refers to concomitant use of drugs, such as antiplatelet agents,
non-steroidal anti-inflammatory drugs, or alcohol abuse, etc.
INR = international normalised ratio