Complete a HAS-BLED Score Assessment and Log it to an EMR Automatically
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The American College of Cardiology cites the HAS-BLED score as an effective means of assessing stroke risk.
This snippet runs through each question in the HAS-BLED assessment, outputting a score and risk. Easily add the assessment and results to a patient's chart in your EMR.
The HAS-BLED assessment may be used in conjunction with the CHA2DS2-VASc Score
HAS-BLED score
Hypertension: {formmenu: default=; yes; no; name=hypertension}
Uncontrolled, >160 mmHg systolic
Renal Disease: {formmenu: default=; yes; no; name=renal} Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Liver Disease: {formmenu: default=; yes; no; name=liver} Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal
Stroke History: {formmenu: default=; yes; no; name=stroke}
Prior major bleeding or predisposition to bleeding: {formmenu: default=; yes; no; name=prior}
Labile INR: {formmenu: default=; yes; no; name=labile} Unstable/high INRs, time in therapeutic range <60%
Age >65 {formmenu: default=; yes; no; name=age}
Medication usage predisposing to bleeding: {formmenu: default=; yes; no; name=medication} Aspirin, clopidogrel, NSAIDs
Alcohol use: {formmenu: default=; yes; no; name=alcohol} ≥8 drinks/week
{=score} points {if: score=0}Risk was 0.9% in one validation study (Lip 2011) and 1.13 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation should be considered: Patient has a relatively low risk for major bleeding (~1/100 patient-years).{elseif: score=1}Risk was 3.4% in one validation study (Lip 2011) and 1.02 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation should be considered: Patient has a relatively low risk for major bleeding (~1/100 patient-years).{elseif: score=2}Risk was 4.1% in one validation study (Lip 2011) and 1.88 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation can be considered, however patient does have moderate risk for major bleeding (~2/100 patient-years).{elseif: score=3}Risk was 5.8% in one validation study (Lip 2011) and 3.72 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score=4}Risk was 8.9% in one validation study (Lip 2011) and 8.70 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score=5}Risk was 9.1% in one validation study (Lip 2011) and 12.50 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score>5}Scores greater than 5 were too rare to determine risk, but are likely over 10%.
Alternatives to anticoagulation should be considered: Patient is at very high risk for major bleeding.{endif}{score=count(filter(merge([hypertension], [renal], [liver], [stroke], [prior], [labile], [age], [medication], [alcohol]), x -> x="yes"))}
Renal Disease: {formmenu: default=; yes; no; name=renal} Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Liver Disease: {formmenu: default=; yes; no; name=liver} Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal
Stroke History: {formmenu: default=; yes; no; name=stroke}
Prior major bleeding or predisposition to bleeding: {formmenu: default=; yes; no; name=prior}
Labile INR: {formmenu: default=; yes; no; name=labile} Unstable/high INRs, time in therapeutic range <60%
Age >65 {formmenu: default=; yes; no; name=age}
Medication usage predisposing to bleeding: {formmenu: default=; yes; no; name=medication} Aspirin, clopidogrel, NSAIDs
Alcohol use: {formmenu: default=; yes; no; name=alcohol} ≥8 drinks/week
{=score} points {if: score=0}Risk was 0.9% in one validation study (Lip 2011) and 1.13 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation should be considered: Patient has a relatively low risk for major bleeding (~1/100 patient-years).{elseif: score=1}Risk was 3.4% in one validation study (Lip 2011) and 1.02 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation should be considered: Patient has a relatively low risk for major bleeding (~1/100 patient-years).{elseif: score=2}Risk was 4.1% in one validation study (Lip 2011) and 1.88 bleeds per 100 patient-years in another validation study (Pisters 2010).
Anticoagulation can be considered, however patient does have moderate risk for major bleeding (~2/100 patient-years).{elseif: score=3}Risk was 5.8% in one validation study (Lip 2011) and 3.72 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score=4}Risk was 8.9% in one validation study (Lip 2011) and 8.70 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score=5}Risk was 9.1% in one validation study (Lip 2011) and 12.50 bleeds per 100 patient-years in another validation study (Pisters 2010).
Alternatives to anticoagulation should be considered: Patient is at high risk for major bleeding.{elseif: score>5}Scores greater than 5 were too rare to determine risk, but are likely over 10%.
Alternatives to anticoagulation should be considered: Patient is at very high risk for major bleeding.{endif}{score=count(filter(merge([hypertension], [renal], [liver], [stroke], [prior], [labile], [age], [medication], [alcohol]), x -> x="yes"))}
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Note: This snippet is based on an original calculator by Dr. Ron Pisters, found here, on mdcalc.com. We recommend validating the outcomes of this snippet against standards to ensure that the result is accurate to those standards.
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