{
  "slug": "has-bled-score",
  "title": "HAS-BLED Bleeding Risk Calculator",
  "heading": "HAS-BLED Score Calculator",
  "category": "fitness-health",
  "url": "https://www.revenuelab.fyi/toolbox/has-bled-score",
  "summary": "Estimate major bleeding risk on anticoagulation for atrial fibrillation.",
  "description": "HAS-BLED estimates one-year risk of major bleeding in patients on anticoagulation for atrial fibrillation, weighing Hypertension (uncontrolled, systolic over 160), Abnormal renal or liver function (1 point each, up to 2), prior Stroke, Bleeding history or predisposition, Labile INR (for warfarin patients), Elderly (age over 65), and Drugs or alcohol (antiplatelet/NSAID use, or excess alcohol; 1 point each, up to 2), for a maximum score of 9. A score of 3 or higher indicates elevated bleeding risk requiring closer monitoring and modification of reversible risk factors, not automatic withholding of anticoagulation — HAS-BLED was designed to identify and correct modifiable bleeding risks (uncontrolled BP, concurrent NSAID use, labile INR) rather than to disqualify high-stroke-risk patients from needed anticoagulation. It should always be interpreted alongside CHA2DS2-VASc, since many patients with high bleeding risk also have high stroke risk, and the net clinical benefit of anticoagulation often still favors treatment with closer monitoring. This tool is for education and workflow support only — not medical advice. Always verify results with a clinician and use clinical judgment alongside your institution's protocols.",
  "formula": "1 point each for: uncontrolled HTN, abnormal renal function, abnormal liver function, stroke history, bleeding history, labile INR, age>65, drug/alcohol use (2 categories, max 2).",
  "dateModified": "2026-09-30",
  "run_url": "https://www.revenuelab.fyi/api/public/calc?tool=has-bled-score",
  "inputs": [
    {
      "id": "htn",
      "label": "Uncontrolled hypertension (SBP >160)",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "renal",
      "label": "Abnormal renal function (dialysis, transplant, Cr >2.26 mg/dL)",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "liver",
      "label": "Abnormal liver function (cirrhosis, bilirubin/enzymes >2x normal)",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "stroke",
      "label": "Prior stroke",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "bleeding",
      "label": "Prior major bleeding or predisposition",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "labileInr",
      "label": "Labile INR (if on warfarin)",
      "kind": "select",
      "hint": null,
      "default": "no",
      "options": [
        {
          "value": "yes",
          "label": "Yes (+1)"
        },
        {
          "value": "no",
          "label": "No"
        }
      ]
    },
    {
      "id": "age",
      "label": "Age",
      "kind": "number",
      "hint": null,
      "default": 70,
      "unit": "years",
      "min": 18,
      "max": 110
    },
    {
      "id": "drugsAlcohol",
      "label": "Antiplatelet/NSAID use and/or excess alcohol",
      "kind": "select",
      "hint": null,
      "default": "none",
      "options": [
        {
          "value": "none",
          "label": "Neither"
        },
        {
          "value": "one",
          "label": "One (+1)"
        },
        {
          "value": "both",
          "label": "Both (+2)"
        }
      ]
    }
  ],
  "outputs": [
    {
      "id": "score",
      "label": "HAS-BLED score",
      "format": "number",
      "hint": null,
      "primary": true
    },
    {
      "id": "risk",
      "label": "Bleeding risk category",
      "format": "raw",
      "hint": null,
      "primary": false
    }
  ],
  "worked_example": {
    "inputs": [
      "Uncontrolled hypertension (SBP >160): No",
      "Abnormal renal function (dialysis, transplant, Cr >2.26 mg/dL): No",
      "Abnormal liver function (cirrhosis, bilirubin/enzymes >2x normal): No",
      "Prior stroke: No",
      "Prior major bleeding or predisposition: No",
      "Labile INR (if on warfarin): No",
      "Age: 70 years",
      "Antiplatelet/NSAID use and/or excess alcohol: Neither"
    ],
    "outputs": [
      "HAS-BLED score: 1",
      "Bleeding risk category: Low bleeding risk"
    ]
  },
  "how_to": {
    "title": "How to use this",
    "steps": [
      "Enter uncontrolled hypertension (sbp >160).",
      "Enter abnormal renal function (dialysis, transplant, cr >2.26 mg/dl).",
      "Enter abnormal liver function (cirrhosis, bilirubin/enzymes >2x normal).",
      "Enter prior stroke.",
      "Enter prior major bleeding or predisposition.",
      "Enter labile inr (if on warfarin).",
      "Enter age (years).",
      "Enter antiplatelet/nsaid use and/or excess alcohol.",
      "Read your has-bled score on the right — it updates as you type.",
      "Hit Share to keep the scenario or send it to someone."
    ]
  },
  "scenarios": [
    {
      "name": "Conservative",
      "description": "Lower-end numbers — what if things land soft?",
      "values": {
        "htn": "no",
        "renal": "no",
        "liver": "no",
        "stroke": "no",
        "bleeding": "no",
        "labileInr": "no",
        "age": 70,
        "drugsAlcohol": "none"
      }
    },
    {
      "name": "Typical",
      "description": "Defaults — the most common real-world setup.",
      "values": {
        "htn": "no",
        "renal": "no",
        "liver": "no",
        "stroke": "no",
        "bleeding": "no",
        "labileInr": "no",
        "age": 70,
        "drugsAlcohol": "none"
      }
    },
    {
      "name": "Ambitious",
      "description": "Higher-end numbers — what if things really pop?",
      "values": {
        "htn": "no",
        "renal": "no",
        "liver": "no",
        "stroke": "no",
        "bleeding": "no",
        "labileInr": "no",
        "age": 70,
        "drugsAlcohol": "none"
      }
    }
  ],
  "limitations": [
    "Population formulas describe averages; individual bodies vary, especially at the extremes of height, age, or muscle mass.",
    "Results do not account for medical conditions, medication, or pregnancy.",
    "Use this as a directional reference, not a diagnosis — talk to a clinician before acting on it."
  ],
  "faq": [
    {
      "q": "Does a high HAS-BLED score mean anticoagulation should be stopped?",
      "a": "No, not by itself. HAS-BLED was designed to flag correctable risk factors — poorly controlled blood pressure, concurrent NSAID or antiplatelet use, unstable INR — so they can be addressed while continuing anticoagulation, since most high-bleeding-risk AF patients also have high stroke risk and still benefit from treatment."
    },
    {
      "q": "Should HAS-BLED and CHA2DS2-VASc be used together?",
      "a": "Yes, they're meant to be complementary. CHA2DS2-VASc estimates the benefit of anticoagulation (stroke prevention) while HAS-BLED estimates the cost (bleeding risk); the anticoagulation decision weighs both, and a high score on both tools usually still favors anticoagulation with closer monitoring rather than withholding treatment."
    },
    {
      "q": "What counts as 'labile INR'?",
      "a": "Generally defined as time in therapeutic range below 60%, or INR values that are frequently high or low despite consistent dosing efforts. This criterion only applies to patients on warfarin — it's not applicable to patients on a direct oral anticoagulant, which doesn't require INR monitoring."
    },
    {
      "q": "What's the most actionable item on this score?",
      "a": "Blood pressure control and eliminating unnecessary concurrent NSAID or antiplatelet use are the two most directly modifiable factors, and addressing them can meaningfully lower real bleeding risk even without changing the anticoagulation decision itself."
    }
  ],
  "related": [
    "https://www.revenuelab.fyi/toolbox/cha2ds2-vasc-score",
    "https://www.revenuelab.fyi/toolbox/wells-dvt-score",
    "https://www.revenuelab.fyi/toolbox/child-pugh-score"
  ],
  "license": "CC-BY-4.0",
  "citation": "RevenueLab — HAS-BLED Bleeding Risk Calculator (https://www.revenuelab.fyi/toolbox/has-bled-score)"
}