Bleeding Risk
HAS-BLED Calculator
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.
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
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Renal Function

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