HAS-BLED calculator
Major bleeding risk on anticoagulation for atrial fibrillation.
Dialysis, transplant or creatinine > 2.26 mg/dL (200 µmol/L).
Cirrhosis, or bilirubin > 2× normal with AST/ALT/ALP > 3× normal.
Time in therapeutic range below 60%. Warfarin only.
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This is a reference implementation of a published formula, provided for use by qualified healthcare professionals. It does not diagnose, does not account for the individual circumstances of any patient, and is not a recommendation for treatment. Confirm every result against your own institutional guidance before acting on it. Clinical judgement always takes precedence over a calculator.
About this calculation
HAS-BLED estimates one-year major bleeding risk in anticoagulated patients with atrial fibrillation. Its intended use is to identify and correct modifiable risk factors and to flag patients needing closer review — not to withhold anticoagulation.
Formula
One point each: H A S B L E D — hypertension, abnormal renal/liver, stroke, bleeding, labile INR, elderly, drugs/alcohol
- Source
- Pisters R et al., Chest (2010)
- Methodology version
- 1.0.0
- Last reviewed
- 2026-10-28
What this does not account for
- A high HAS-BLED is not a reason to withhold anticoagulation. Its purpose is to prompt correction of the modifiable factors — blood pressure, concurrent NSAIDs, alcohol, INR control — and closer follow-up.
- Bleeding risk and stroke risk rise together, so the patients who score highest here are often those with the most to gain from anticoagulation.
- The labile INR criterion applies only to warfarin and has no meaning for a direct oral anticoagulant.
- Derived in a European cohort on vitamin K antagonists; performance on DOACs is less well established.