Question 1

Should a high HAS-BLED score prevent me from anticoagulating a patient?

Accepted Answer

No — a high HAS-BLED score should prompt a review of modifiable bleeding risks, not a blanket decision to withhold anticoagulation. The stroke risk reduction with anticoagulation often outweighs the bleeding risk even at HAS-BLED ≥3. Involve the patient in shared decision-making.

Question 2

Does HAS-BLED apply equally to warfarin and DOAC patients?

Accepted Answer

Labile INR is a component specific to warfarin. For patients on a DOAC, the Drug and Alcohol component still applies. The score still performs well for DOAC patients, as the other components (e.g., age, renal function, bleeding history) are common to all anticoagulants.

Question 3

When should I re-calculate HAS-BLED?

Accepted Answer

At the time of anticoagulation initiation and then at least annually, or sooner if the patient develops a new bleeding risk factor (worsening renal function, new antiplatelet requirement, alcohol misuse).