HAS-BLED - a scale for assessing the risk of bleeding. Acronym from Hypertension, Abnormal renal-liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (65 years), Drugs or alcohol concomitantly. an important clinical tool to replace the more sophisticated HEMOR2RAGES . Used to assess the risk of major bleeding within 1 year.
Content
History
It was developed in 2010 [1] by a group of scientists from the University of Maahstria under the leadership of Ron Pisters. The scale was tested and proved effective in a cohort of 3678 patients with atrial fibrillation . Some of these patients (65%) took oral anticoagulants (13% of them with aspirin and / or clopidogrel), 24% - antiplatelet agents , 10% - did not take any antiplatelet therapy. The bleeding rate was 0.75%, 0.97%, and 1.42%, respectively [2] , which correlated well with the results of the HAS-BLED assessment.
Contents
The scale contains 9 points, each of which is rated at 1 point (in the “medication” section, 1 point for each medicine is added) [3] .
| Index | Indicator | Comment | Points |
|---|---|---|---|
| Hypertension | Hypertension | Uncontrolled, systolic blood pressure > 160 mm Hg. Art. | 1 b |
| Abnormal liver function | Impaired liver function | cirrhosis, violations in liver tests: bilirubin> 2 norms + ALT / AST / alkaline phosphatase > 3 norms | 1 b |
| Renal disease | Impaired renal function | dialysis , kidney transplantation, creatinine more than 200 μmol / l | 1 b |
| Stroke history | A history of stroke | Especially lacunar | 1 b |
| Priority major bleeding | Bleeding | History of major bleeding (intracranial, or requiring hospitalization, or with a decrease in Hb> 2 g / l, or requiring blood transfusion ), anemia, or a predisposition to bleeding | 1 b |
| Labile inr | Labile INR | <60% of the time in the therapeutic range, high INR | 1 b |
| Age> 65 | Age> 65 | more than 65 years | 1 b |
| Medication Usage Predisposing to Bleeding | Taking medication | taking drugs that increase the risk of bleeding: antiplatelet agents, NSAIDs | 1 b |
| Alcohol Usage History | Alcohol abuse | > 8 glasses per week | 1 b |
Interpretation
A score of 3 or more is associated with a high risk of bleeding (3.74 bleeding per 100 patient-years).
A result of 2 points or less - there is no significant increase in the risk of bleeding (1.88 bleeding per 100 patient-years), but careful monitoring is necessary [4]
Notes
- ↑ Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleedingin patients with atrial fibrillation: The Euro Heart Survey. Chest. 2010; 138 (5): 1093
- ↑ Giuseppe Boriani, MD, PhD, Igor Diemberger, MD, PhD, Mauro Biffi, MD, Cristian Martignani, M. Balancing the Ris kof Hemorrhage vs Thromboembolism in Patients With Atrial Fibrillation. How To Navigate Between Scyllaand Charybdis? Bologna, Italy. 2011
- ↑ Inaccessibility A.V. How to treat arrhythmias. Rhythm and conduction disorders in clinical practice. 5th ed. - M.: MEDpress-inform, 2011./
- ↑ CHA2DS2VASc / HAS-BLED / EHRA atrial fibrillation risk score calculator By Jonas de Jong