ISTH major bleeding in non-surgical patients is defined as having a symptomatic presentation and 1: Bleeding causing a fall in hemoglobin level of 20 g L−1 (1.24 mmol L−1) or more, or leading to transfusion of two or more units of whole blood or red cells.

RE-LY definition of life-threatening bleeding: ≥ 1 of the following criteria: (1) fatal, symptomatic intracranial bleed; (2) reduction in hemoglobin level of at least 5.0 g/L; (3) transfusion of at least 4 U of blood or packed cells; (4) associated with hypotension requiring the use of intravenous inotropic agents; or …

Dangerous blood loss due to blood vessel injury. View All Glossary Terms.

International Society of Thrombosis and Hemostasis

narrow passage connecting two cavities

The HAS-BLED score is the recommended score in the ESC and Canadian guidelines for this purpose. HAS-BLED has been well validated,4-6 and has been shown to outperform other risk scores (including HEMORR(2)HAGES and ATRIA) in predicting clinically relevant bleeding.

IV. Interpretation

1. Score 0 points: Major bleeding risk 1% per year.
2. Score 1 points: Major bleeding risk 3.4% per year.
3. Score 2 points: Major bleeding risk 4.1% per year.
4. Score 3 points: Major bleeding risk 5.8% per year.
5. Score 4 points: Major bleeding risk 8.9% per year.
6. Score 5 points: Major bleeding risk 9.1% per year.

Classification of CHADS2 vs CHADS2-VASc In both scoring systems, a score of 0 is “low” risk of stroke, 1 is “moderate”, and any score above 1 is a “high” risk.

It was developed in 2010 with data from 3,978 people in the Euro Heart Survey. Major bleeding is defined as being intracranial bleedings, hospitalization, hemoglobin decrease > 2 g/dL, and/or transfusion….HAS-BLED.

The novel oral anticoagulants (NOACs) are a new class of anticoagulant drug. They can be used in the prevention of stroke for people with non-valvular AF, which is when AF is not associated with a problem in a heart valve.

Note: HAS-BLED = Hypertension, Abnormal liver/renal function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly; ATRIA = Anticoagulation and Risk Factors in Atrial Fibrillation; M-H = Mantel-Haenszel; CI = confidence interval.

Our study demonstrates that patients with a HAS-BLED score ≥ 3 points are at 8-fold increased risk of major bleeding complications during the first 180 days of VKA treatment. However, despite a good specificity and negative predictive value, the sensitivity of the HAS-BLED score at this cut-off was only 54.6%.

The HAS-BLED Score was developed as a practical risk score to estimate the 1-year risk for major bleeding in patients with atrial fibrillation. Study included 5,333 ambulatory and hospitalized patients with AF from both academic and non-academic hospitals in 35 member countries of the European Society for Cardiology.

The CHA2DS2-VASc Score is the most commonly utilized method to predict thromboembolic risk in atrial fibrillation. CHA2DS2 stands for (Congestive heart failure, Hypertension, Age ( > 65 = 1 point, > 75 = 2 points), Diabetes, previous Stroke/transient ischemic attack (2 points).

Clinical Perspective The HAS‐BLED score has been widely used for risk stratification in patients with atrial fibrillation receiving anticoagulation. This study shows that HAS‐BLED has high predictive validity for bleeding events in venous thromboembolism (VTE) patients receiving anticoagulation.