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Journal of the American College of Cardiology

Clinical Articles, News & Views

HAS-BLED score superior for bleeding prediction

The HAS-BLED risk-estimation score performed better than HEMORR2HAGES and ATRIA for predicting clinically relevant bleeding, according to a study published recently in the Journal of the American College of Cardiology.1

Only HAS-BLED demonstrated a significant predictive performance for intracranial haemorrhage, the authors say. Given its simplicity, the HAS-BLED score may be an attractive method for the estimation of oral anticoagulant-related bleeding risk for use in clinical practice, supporting recommendations in international guidelines, they add.

Researchers analysed the dataset from the AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) trial, a multicenter, open-label noninferiority study that compared fixed-dose idraparinux with adjustable-dose oral vitamin K antagonist therapy in patients with AF. The principal safety outcome was any clinically relevant bleeding event, which was a composite of major bleeding plus clinically relevant nonmajor bleeding.

The HAS-BLED score performed best in predicting any clinically relevant bleeding, reflected both in net reclassification improvement (10.3% and 13% improvement compared with HEMORR2HAGES and ATRIA, respectively) and receiver-operating characteristic (ROC) analyses (c-indexes: 0.60 vs. 0.55 and 0.50 for HAS-BLED vs. HEMORR2AGES and ATRIA, respectively).

Using decision-curve analysis, the HAS-BLED score demonstrated superior performance compared with ATRIA and HEMORR2HAGES at any threshold probability for clinically relevant bleeding. HAS-BLED was the only score that demonstrated a significant predictive performance for intracranial haemorrhage (c-index: 0.75). An ATRIA score >3 was not significantly associated with the risk for any clinically relevant bleeding on Cox regression or on ROC analysis.


1. Apostolakis S, Lane DA, Guo Y, Buller H, Lip GYH. Performance of the HEMORR2HAGES, ATRIA, and HAS-BLED bleeding risk–prediction scores in patients with atrial fibrillation undergoing anticoagulation. JACC 2012. In Press.

Published on: August 24, 2012

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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