• Assessment of 1-year major bleeding risk in patients with atrial fibrillation.
• Guidance for anticoagulation therapy planning (Warfarin or DOACs).
• Identification of modifiable bleeding risk factors to improve patient safety.

The score aggregates major physiological and lifestyle predictors of haemorrhage. Hypertension and prior stroke reflect underlying vascular fragility, while renal/liver dysfunction impairs coagulation factor synthesis and drug clearance.

• Uncontrolled hypertension: Aim for SBP < 160 mmHg to reduce intracranial hemorrhage (ICH) risk.
• Concurrent use of NSAIDs or aspirin: Often unnecessary in AF and markedly increases bleeding risk.
• Excessive alcohol consumption: > 8 drinks/week increases risk of trauma-related bleeding and liver dysfunction.
• Sub-optimal INR monitoring: TTR (Time in Therapeutic Range) < 60% predicts high risk on Warfarin.

While HAS-BLED is mnemonic-based and easy to use at the bedside, newer biomarker-based scores like the ABC (Age, Biomarkers, Clinical history) score are now considered more accurate if hs-Troponin and GDF-15 are available.

• Identify and correct modifiable risks (BP, NSAIDs, Alcohol).
• Consider DOAC over Warfarin (lower intracranial bleed risk).
• Schedule more frequent follow-up (e.g., month 1, then quarterly).
• Ensure the patient is aware of bleeding warning signs (melena, bruising).

Dutch cardiologist who developed the score as part of his research into stroke prevention and bleeding risk in atrial fibrillation management.

The score was developed to replace older, more complex bleeding risk models that were difficult to use in daily clinical practice. HAS-BLED was specifically designed to be mnemonic-friendly.