Should HAS-BLED scoring be revised for better risk estimation in patients with intracerebral hemorrhage?

Abstract

Many efforts have been made to develop decision-support tools and bleeding prediction schemes to start or resume anticoagulation after intracerebral hemorrhage, related with anticoagulation use or not, such as CHA₂DS₂-VASc or HAS-BLED scoring. HAS-BLED is a validated scoring system to predict the risk of major bleeding in a patient with atrial fibrillation; some current scientific guidelines suggest its use in ‘risk–benefit’ reasoning when deciding whether to start long-term oral anticoagulation. Here the authors present a patient with atrial fibrillation and intracerebral hemorrhage, and aim to discuss the use of HAS-BLED, suggesting that some revisions may help better management of these patients for major bleeding risk.

Keywords::

• anticoagulation
• bleeding risk
• HAS-BLED scoring
• intracerebral hemorrhage
• revisions

Acknowledgements

We would like to thank M Marcucci (University of Milan, Italy) for her great and valuable contributions in revising our manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.