A patient with atrial fibrillation has a HAS-BLED score of 2. What does this indicate about bleeding risk?

• A. Low
• B. Moderate
• C. High
• D. Very high

Answer: (B)

HAS-BLED is used to estimate the 1-year risk of major bleeding in patients with atrial fibrillation who may be treated with anticoagulation. Each risk factor in the score adds one point, covering hypertension, abnormal renal or liver function, prior stroke, prior bleeding or predisposition to bleeding, unstable or labile INRs, age over 65, and concomitant use of drugs or alcohol. A total of two indicates a moderate bleeding risk. This means the patient isn’t in the low-risk category, but the risk is not in the high range either. It signals that if anticoagulation is used, you should optimize modifiable factors (like controlling blood pressure, reviewing drug interactions and alcohol use, ensuring stable INR if on warfarin, and monitoring closely) and weigh the stroke risk against bleeding risk. It does not automatically rule out anticoagulation, especially if the stroke risk from AF is substantial.