Health risk tools

HAS-BLED: AFib bleeding risk

Educational only, not a diagnosis. Educational information about published risk tools. Not medical advice or a diagnosis, and it does not create a doctor–patient relationship. Do not start, stop, or change any medication, including blood thinners, without your clinician. Everything you enter stays in this browser; nothing is sent anywhere. In an emergency, call 911.

For adults with atrial fibrillation who are on, or considering, a blood thinner. One point for each item that applies (maximum 9).

H — Uncontrolled high blood pressure (systolic over 160)
A — Abnormal kidney function
A — Abnormal liver function
S — Prior stroke
B — Prior major bleeding, or a tendency to bleed
L — Unstable (labile) INR on warfarin
E — Elderly: age over 65
D — Drugs: aspirin/antiplatelet or NSAID use
D — Alcohol use (heavy)

HAS-BLED: 0 / 9

A score under 3 is not labeled higher bleeding risk. Modifiable items are still worth reviewing with your clinician.

In the original 3,978-patient study, people with a score of 0 had about 1.13 major bleeds per 100 patient-years.

U.S. and European guidelines say a bleeding score alone should not be the reason to withhold a blood thinner. Never stop or change a blood thinner on your own.

Where it does not apply

Mechanical heart valves or moderate-to-severe mitral stenosis.
Predicting bleeding with clots in the legs or lungs (VTE/DVT/PE).
Deciding by itself whether to start or stop a blood thinner.
Active bleeding: that is an emergency. Call 911.
Children or pregnancy.

It was built mostly in the warfarin era; “labile INR” applies only to warfarin, and rates on newer blood thinners may differ. Stroke risk (CHA₂DS₂-VASc) and bleeding risk are separate conversations, held together with your clinician.

Sources

Pisters R et al. Chest 2010;138:1093–1100 (derivation; 3,978 patients; Table 5 rates). doi
2023 ACC/AHA/ACCP/HRS AF Guideline (Joglar et al.), Circulation 2024;149:e1–e156: a bleeding score alone should not be used to decide against anticoagulation. doi
2024 ESC AF Guidelines (Van Gelder et al.), Eur Heart J 2024;45:3314. doi
Lip GY et al. JACC 2011;57:173–180 (external validation). doi