Assessing Bleeding Risk in Atrial Fibrillation: The Has-BLED Score Calculator

Based on the data from a meta-analysis published in 2005 in the journal Clinical Cardiology^[1], the HAS-BLED score outperforms other bleeding risk scores (HEMORR2HAGES and ATRIA) as well as stroke risk scores (CHADS2 and CHA2DS2-VASc), and this superiority remains evident even among atrial fibrillation patients who are not receiving anticoagulant therapy, where the study notes a significant improvement compared to all other tested scores (HEMORR2HAGES and ATRIA).

The research conducted on the AMADEUS trial (article from 2017)^[6] drew the following conclusions regarding the performance of the HAS-BLED score:

• After a follow-up period of 347 days, a significant percentage of patients (13.0%) experienced clinically relevant bleeding events, and a smaller percentage (2.5%) had major bleeding.
• Among the different bleeding risk assessment scores, only the HAS-BLED score showed a significant association with the risk of clinically relevant bleeding.
• The "modifiable bleeding risk factors score" was not significantly associated with clinically relevant bleeding events.
• Both scores had limited ability to predict bleeding events, but the HAS-BLED score performed slightly better than the "modifiable bleeding risk factors score."
• The HAS-BLED score, when combined with one, two, or three modifiable factors, outperformed the "modifiable bleeding risk factors score" with the same number of modifiable risk factors.
• In conclusion, compared to an approach based solely on modifiable bleeding risk factors, the HAS-BLED score was significantly better at predicting clinically relevant bleeding in the trial cohort.

While addressing modifiable bleeding risk factors is important for all patients with atrial fibrillation (AF), using a formal bleeding risk score like HAS-BLED can provide better predictive value for bleeding risks and assist in identifying high-risk patients for reviews and follow-up.

The Has-BLED score is primarily used by healthcare professionals involved in the management of patients with atrial fibrillation (AF) who require anticoagulant therapy. These professionals can include:

1. Cardiologists: Cardiologists are specialists in the diagnosis and treatment of heart diseases, including atrial fibrillation. They often assess the risk of bleeding in AF patients and determine the appropriate anticoagulation strategy based on factors such as the Has-BLED score.
2. Electrophysiologists: Electrophysiologists specialize in the electrical activities of the heart, including the treatment of arrhythmias like atrial fibrillation. They may use the Has-BLED score to evaluate bleeding risks and guide their decisions on anticoagulation therapy for their patients.
3. Hematologists: Hematologists are experts in blood disorders and play a crucial role in managing patients on anticoagulant therapy. They may utilize the Has-BLED score to assess bleeding risks and provide recommendations regarding anticoagulation management.
4. Internal Medicine Physicians: Internal medicine physicians often care for patients with chronic medical conditions, including atrial fibrillation. They may use the Has-BLED score to evaluate bleeding risks, monitor anticoagulation therapy, and coordinate care with other specialists.
5. Primary Care Physicians: Primary care physicians are often the first point of contact for patients and are involved in the management of various health conditions. They may use the Has-BLED score to assess bleeding risks in AF patients, initiate anticoagulation therapy, and refer patients to specialists as needed.

While the Has-BLED score is primarily utilized by the aforementioned specialists, its application can extend to other healthcare professionals involved in the care of patients with atrial fibrillation, such as nurse practitioners, physician assistants, and clinical pharmacists, who may collaborate with the primary treating physicians to assess bleeding risks and optimize anticoagulation therapy.

The Glasgow-Blatchford score (GBS) and the Has-BLED score serve different purposes in the medical field. Here's a brief explanation of when each score is commonly used:

The Glasgow-Blatchford score is primarily used in the assessment of patients with upper gastrointestinal bleeding (UGIB). It helps in determining the need for medical intervention, such as hospitalization, blood transfusion, or endoscopic intervention.

The GBS takes into account various clinical and laboratory parameters, such as blood pressure, heart rate, hemoglobin levels, and other factors to stratify the severity of UGIB and guide the appropriate management approach.

On the other hand, the Has-BLED score is specifically designed for patients with atrial fibrillation (AF) who are on anticoagulant therapy. It evaluates the risk of bleeding in these patients to assist healthcare professionals in decision-making regarding anticoagulation management. The score considers factors like hypertension, renal/liver function, bleeding history, and others to assess the risk of bleeding events and aid in selecting the most appropriate anticoagulant strategy while balancing stroke prevention benefits.

In summary, the Glasgow-Blatchford score is used for assessing upper gastrointestinal bleeding, while the Has-BLED score is employed to evaluate bleeding risk in patients with atrial fibrillation on anticoagulant therapy. Each score is tailored to a specific clinical scenario and assists healthcare providers in making informed decisions regarding patient management and intervention.