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Claridge et al are correct to highlight that the HASBLED score is
featured in international guidelines (1) for use predicting the bleeding
risk in anticoagulated patients in atrial fibrillation. It should be
highlighted, however, that there common features within the CHA2DS2-VASc
and HAS-BLED scores. Previous stroke, a history of hypertension and age
over 65 years all increasing the risk of both stroke and major bleeding.
The European Society Guidelines suggest that the HAS-BLED score may be
used to direct alternative anticoagulation therapies to warfarin - dabigatran (2). The HAS-BLED score however needs to be validated in this
setting. In situations where both the perceived bleeding risk and stroke
risk is high the ultimate decision to anticoagulate should be an educated
informed patient choice.
2 - Camm AJ, Kirchhof P, Lip GYH et al. The Task Force for the
Management of Atrial Fibrillation of the European Society of Cardiology.
Guidelines for the management of atrial fibrillation. European Heart
Journal (2010) 31, 2369-242