Condition Points H Hypertension: (uncontrolled, >160 mmHg systolic) 1 A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal 1 1 S Stroke: Prior history of stroke 1 B Bleeding: Prior Major Bleeding or Predisposition to Bleeding 1 L Labile INR: (Unstable/high INR), Time in Therapeutic Range 1 E Elderly: Age > 65 years 1 D Prior Alcohol or Drug Usage History (≥ 8 drinks/week) Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs) 1 1 A calculated<unk>  score is between 0 and 9 and based on seven parameters with a weighted value of 0-2. The<unk>  mnemonic stands for: * Hypertension * Abnormal renal and liver function * Stroke * Bleeding * Labile INR * Elderly * Drugs or alcohol A study comparing HEMORR2HAGES, ATRIA and<unk>  showed superior performance of the<unk>  score compared to the other two. Mixed evidence exist on the comparison between GARFIELD-AF bleeding score over the<unk> . 2020 ESC guidelines on atrial fibrillation recommend assessment of bleeding risk in AF using the<unk>  bleeding risk schema as a simple, easy calculation, whereby a score of ≥3 indicates "high risk" and some caution and regular review of the patient is needed. The<unk>  score has also been validated in an anticoagulated trial cohort of 7329 people with AF - in this study, the<unk>  score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply. With the likely availability of new oral anticoagulants that avoid the limitations of warfarin (and may even be safer), more widespread use of oral anticoagulation therapy for stroke prevention in AF is likely. While their use is recommended in clinical practice guidelines, they are only moderately effective in predicting bleeding risk and don't perform well in predicting hemorrhagic stroke. Bleeding risk may be increased in patients on haemodialysis.
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