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Original Research: ANTITHROMBOTIC THERAPY |

A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk of Major Bleeding in Patients With Atrial Fibrillation: The Euro Heart Survey

Ron Pisters, MD; Deirdre A. Lane, PhD; Robby Nieuwlaat, PhD; Cees B. de Vos, MD; Harry J. G. M. Crijns, MD; Gregory Y. H. Lip, MD; Guideline Development Group for the NICE national clinical guideline for management of atrial fibrillation in primary and secondary care; Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation
Author and Funding Information

From the Department of Cardiology (Drs Pisters, Nieuwlaat, de Vos, and Crijns), Maastricht University Medical Centre, Maastricht, The Netherlands; and the University of Birmingham Centre for Cardiovascular Sciences (Drs Lane and Lip), City Hospital, Birmingham, England.

Correspondence to: Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, England; e-mail: g.y.h.lip@bham.ac.uk


For editorial comment see page 1032.

Funding/Support: The Euro Heart Survey has as industry sponsors the main sponsor, AstraZeneca; major sponsor, Sanofi-Aventis; and sponsor, Eucomed. Funding institutions are the Austrian Heart Foundation, Austrian Society of Cardiology, French Federation of Cardiology, Hellenic Cardiological Society, Netherlands Heart Foundation, Portuguese Society of Cardiology, Spanish Cardiac Society, Swedish Heart and Lung Foundation, and individual centers.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1093-1100. doi:10.1378/chest.10-0134
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Objective:  Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease > 2 g/L, and/or transfusion) in a cohort of real-world patients with AF.

Methods:  Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort.

Results:  Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using significant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively.

Conclusion:  This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF.


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