A 62-year-old man with paroxysmal AF and CHA2DS2-VASc score of 4 refuses anticoagulation due to recurrent falls. Which assessment tool should be used to evaluate bleeding risk before making the final decision on anticoagulation?
- A HAS-BLED score; score >3 is an absolute contraindication to anticoagulation
- B HAS-BLED score; high score identifies modifiable bleeding risk factors but is NOT an absolute contraindication ✓
- C HEMORR2HAGES score; mandates withholding anticoagulation if >4
- D ATRIA score; anticoagulation should be stopped if score >10
Explanation
The HAS-BLED score (Hypertension, Abnormal liver/renal function, Stroke, Bleeding history/predisposition, Labile INR, Elderly >65, Drugs/alcohol) is recommended by ESC guidelines to identify modifiable bleeding risk factors rather than to deny anticoagulation. A score ≥3 identifies patients at higher bleeding risk in whom modifiable factors should be addressed (e.g., blood pressure control, cessation of NSAIDs, alcohol reduction) but is NOT a reason to withhold anticoagulation in those with high stroke risk. Withholding anticoagulation in AF with high CHA2DS2-VASc exposes patients to a greater net risk than bleeding.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.