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New score to assess bleeding risk in AF

By Lilian Anekwe

A team of UK and Dutch researchers have devised a ‘user-friendly' score to assess an atrial fibrillation patient's one-year risk of major bleeding.

The HAS-BLED score predicts bleeding risk from a combination of risk factors: Hypertension, Abnormal renal or liver function, Stroke, Bleeding history, Labile INR, Elderly over 65, and a history of Drugs – antiplatelets of NSAIDs – or alcohol.

One point is given for each risk factor, with a maximum score of nine.

Researchers defined major bleeding as ‘any bleeding requiring hospitalisation and/or causing a decrease in haemoglobin level of more than 2g/L and/or requiring blood transfusion.'

The annual bleeding rate increased with the addition of each risk factor up to 5 risk factors, which researchers estimated would cause 12.5 major bleeds per 100 patients years. HAS-BLED demonstrated a good predictive accuracy, with a c-statistic of 0.72.

Professor Gregory Lip, professor of cardiology at the University of Birmingham concluded: ‘Physicians could use the HAS-BLED score to assess the potential bleeding risk and feel more confident in prescribing oral anticoagulants.'

Chest, published online March 18 2010

The new score could be used to assess whether AF patients need warfarin