HAS-BLED Score
Estimates 1-year major bleeding risk in AF patients on anticoagulation
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Care settings
- Emergency department, Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The HAS-BLED Score can activate when the transcript or pasted chart context documents any of these:
- Initiating anticoagulation in AFib
- Assessing bleeding risk on anticoagulation
- High-risk patient on anticoagulation
- Anticoagulation re-evaluation
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I48.
Note-type scope: it activates on notes whose subject resolves to cardiology, emergency medicine, critical care, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
8 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Uncontrolled HTN (SBP >160) | history | Uncontrolled hypertension, systolic >160 mmHg (HAS-BLED: 1 point). Asked as: “Is the patient's hypertension uncontrolled (systolic BP >160 mmHg)?” | |
| Abnormal renal function | lab | Chronic dialysis, renal transplant, or creatinine >2.26 mg/dL (HAS-BLED: 1 point). Asked as: “Does the patient have abnormal renal function (dialysis, transplant, or creatinine >2.26 mg/dL)?” | |
| Abnormal liver function | lab | Cirrhosis, or bilirubin >2x ULN with transaminases/ALP >3x ULN (HAS-BLED: 1 point). Asked as: “Does the patient have abnormal liver function (cirrhosis, or bilirubin >2x normal with AST/ALT/ALP >3x normal)?” | |
| Prior stroke | history | Any prior stroke (HAS-BLED: 1 point). Asked as: “Does the patient have a history of prior stroke?” | |
| Prior major bleeding | history | Prior major bleed or bleeding predisposition, including anemia (HAS-BLED: 1 point). Asked as: “Does the patient have a history of major bleeding or a predisposition to bleeding (including anemia)?” | |
| Labile INR (TTR <60%)optional | lab | ||
| Age >65 | age | ||
| NSAIDs/antiplatelets/alcohol use | medication | Concomitant antiplatelet/NSAID use, or ≥8 alcoholic drinks per week (HAS-BLED: 1 point). Asked as: “Is the patient on antiplatelets or NSAIDs, or drinking 8 or more alcoholic drinks per week?” |
Scoring
H=HTN, A=Abnormal renal/liver, S=Stroke, B=Bleeding, L=Labile INR, E=Elderly, D=Drugs/alcohol (1 point each)
HTN Uncontrolled HTN (SBP >160) + Renal Abnormal renal function + Liver Abnormal liver function + Stroke Prior stroke + Bleeding Prior major bleeding + Elderly Age >65 + Drugs/EtOH NSAIDs/antiplatelets/alcohol use
Interpretation
0-1: Low risk (0.9-3.4%/yr). 2: Moderate (4.1%). >=3: High risk (5.8-9.1%). High score does not contraindicate anticoagulation but identifies modifiable risk factors.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Pisters R et al. A novel user-friendly score to assess 1-year risk of major bleeding in AF patientsPisters et al. (HAS-BLED) 2010 · 2010 · Level I · link last verified 2026-03-23
- ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial FibrillationACC/AHA AF 2023 · 2023 · ACC/AHA/ACCP/HRS · Class I, LOE A · link last verified 2026-03-23
How Scribeable handles it in the note
When an encounter activates the HAS-BLED Score at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a HAS-BLED Score value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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