How to Calculate Your Bleeding Risk: HAS-BLED

Despite my love of mechanical watches, I've never been accused of being timely.  So after last Friday's post regarding fall risk (lack of) impact on major bleeding while anticoagulated, I thought it ironic that I almost immediatley stumbled upon another analysis of HAS-BLED, the latest bleeding calculator.  You'll recognize HAS-BLED as the one I've suggested several times to use to balance out the potential down side compared to stroke risk (use CHA2DS2-VASc to calculate stroke risk from atrial fibrillation).

Another analysis?  A study of the validity of HAS-BLED was published in the January 2011 issue of the Journal of the American College of Cardiology.  At that time, the authors analyzed 7,329 participants of the Stroke Prevention Using an ORal Thrombin Inhibitor in Atrial Fibrillation (SPORTIF - did I mention cardiologists create some of the best acronyms?) and concluded that in addition to using HAS-BLED, the addition of diabetes & heart failure to the analysis improved risk prediction.

Well, the team behind this first study has been busy as another anaylsis of HAS-BLED was published online in JACC prior to print later this month.  This time, the authors analyzed 2,292 participants of the AMADEUS trial and compared bleeding risk using ATRIA, HEMORR2HAGES & HAS-BLED.  After some fancy statistical mumbo-jumbo, they concluded that all 3 calculators were only modestly effective at predicting "clinically relevant" bleeding events, but that HAS-BLED was better & simpler than the rest.

Bottom line: while we may not have a crystal ball to predict w/100% accuracy stroke & bleeding risk in atrial fibrillation, we do have some statistical tools to better guide our decision making process.

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