Table 3.
Risk Stratification Tools for Bleeding Risk in Atrial Fibrillation57
| Tool and Citation | Risk Factor* | Score |
|---|---|---|
| HAS-BLED59 | Hypertension (SBP >160 mm Hg) | 1 |
| Abnormal renal or liver function | 1 or 2 | |
| Stroke | 1 | |
| Bleeding history or predisposition | 1 | |
| Labile INRs (if on warfarin) | 1 | |
| Elderly (eg, age >65 y, frail condition) | 1 | |
| Drugs (eg, concomitant antiplatelet or NSAIDs) or alcohol excess/abuse | 1 or 2 | |
| (9 = max. score) | ||
| HEMORRHAGES60 | Hepatic or renal disease | 1 |
| Ethanol abuse | 1 | |
| Malignancy | 1 | |
| Older age (>75 y) | 1 | |
| Reduced platelet count or function | 1 | |
| Re-bleeding risk | 2 | |
| Hypertension (uncontrolled) | 1 | |
| Anemia | 1 | |
| Genetic factors (CYP2C9 SNP) | 1 | |
| Excessive fall risk | 1 | |
| Stroke | 1 | |
| (12 = max. score) | ||
| ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) bleeding61 | Anemia | 3 |
| Severe renal disease (eGFR <30 mL/min/1.73 m2 or dialysis dependent) | 3 | |
| Age ≥75 y | 2 | |
| Prior hemorrhage | 1 | |
| Diagnosed hypertension | 1 | |
| (10 = max. score) |
CYP2C9 = cytochrome P450 2C9; eGFR = estimated glomerular filtration rate; INR = international normalized ratio; NSAIDs = nonsteroidal antiinflammatory drugs; SBP = systolic blood pressure; SNP = single nucleotide polymorphism.
*
First letter of each row spells out the acronym, unless otherwise stated.