Pharmacist Interventions to Reduce Modifiable Bleeding Risk Factors Using HAS-BLED in Patients Taking Warfarin

Use of risk scores and pharmacist follow-up could reduce bleeding risk in patients on anticoagulation therapy.


Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a 5-fold increase in the risk of ischemic stroke and the risk increases with age.1-3 Oral anticoagulation (OAC) therapy effectively reduces the risk of ischemic stroke in patients with nonvalvular AF. However, OAC therapy carries a bleeding risk.4

Several bleeding risk scores have been developed and validated for patients with AF who are taking warfarin: HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk, Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal renal and/or liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, and Drugs and/or alcohol excess concomitantly).4,5

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