❍ Atrial Fibrillation
CHA₂DS₂-VASc + HAS-BLED Workshop
Stroke and bleeding risk in non-valvular AF. Consultation support only -- not for patient self-assessment.
CHA₂DS₂-VASc
0
CHA₂DS₂-VASc Score
HAS-BLED
A: Abnormal organ function (1 pt each)
D: Drugs / alcohol (1 pt each)
0
HAS-BLED Score
Clinical Interpretation
CHA₂DS₂-VASc
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HAS-BLED
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Clinical note
A high HAS-BLED score (≥3) identifies patients who need modifiable bleeding risks addressed -- uncontrolled hypertension, labile INR, concurrent antiplatelet or NSAID use, excessive alcohol. It is not grounds to withhold anticoagulation. In most patients with non-valvular AF, the stroke risk of withholding anticoagulation substantially exceeds the bleeding risk of prescribing it.1 Female sex as the sole risk factor (total score 1, no other clinical risk factors) does not independently warrant anticoagulation per ESC 2020 guidance.1
References
- Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42(5):373-498.
- Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137(2):263-272.
- Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation. Chest. 2010;138(5):1093-1100.
- NZ Heart Foundation. New Zealand Primary Care Handbook: Atrial Fibrillation. Wellington: National Heart Foundation of New Zealand. (Refer to current HealthPathways Canterbury for local guidance.)