A study comparing HEMORR2HAGES, ATRIA and HAS-BLED showed superior performance of the HAS-BLED score compared to the other two.[4] Mixed evidence exist on the comparison between GARFIELD-AF bleeding score over the HAS-BLED.[5][6]
2020 ESC guidelines on atrial fibrillation recommend assessment of bleeding risk in AF using the HAS-BLED bleeding risk schema as a simple, easy calculation,[7] whereby a score of ≥3 indicates "high risk" and some caution and regular review of the patient is needed.[8] The HAS-BLED score has also been validated in an anticoagulated trial cohort of 7329 people with AF - in this study, the HAS-BLED score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply.[9] With the likely availability of new oral anticoagulants that avoid the limitations of warfarin (and may even be safer), more widespread use of oral anticoagulation therapy for stroke prevention in AF is likely.
While their use is recommended in clinical practice guidelines,[10] they are only moderately effective in predicting bleeding risk and don't perform well in predicting hemorrhagic stroke.[11] Bleeding risk may be increased in patients on haemodialysis.[12]
^ abPisters, Ron; Lane, D. A.; Nieuwlaat, R; De Vos, C. B.; Crijns, H. J.; Lip, G. Y. (2010). "A Novel User-Friendly Score (HAS-BLED) to Assess 1-Year Risk of Major Bleeding in Patients with Atrial Fibrillation". Chest. 138 (5): 1093–100. doi:10.1378/chest.10-0134. PMID20299623.
^Dan, Gheorhe-Andre; Steffel, Jan (2019). "4.1. Atrial fibrillation". In Kaski, Juan Carlos; Kjeldsen, Keld Per (eds.). The ESC Handbook on Cardiovascular Pharmacotherapy. Oxford: Oxford University Press. pp. 201–203. ISBN978-0-19-875993-5.
^Lip, Gregory Y.H. (2011). "Implications of the CHA2DS2-VASc and HAS-BLED Scores for Thromboprophylaxis in Atrial Fibrillation". The American Journal of Medicine. 124 (2): 111–4. doi:10.1016/j.amjmed.2010.05.007. PMID20887966.
^Lip, Gregory Y.H.; Frison, Lars; Halperin, Jonathan L.; Lane, Deirdre A. (2011). "Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients with Atrial Fibrillation". Journal of the American College of Cardiology. 57 (2): 173–80. doi:10.1016/j.jacc.2010.09.024. PMID21111555.
^Elliott, Meghan J.; Zimmerman, Deborah; Holden, Rachel M. (2007). "Warfarin Anticoagulation in Hemodialysis Patients: A Systematic Review of Bleeding Rates". American Journal of Kidney Diseases. 50 (3): 433–40. doi:10.1053/j.ajkd.2007.06.017. PMID17720522.
