As with stroke risk scores, most bleeding risk scores based on simple clinical risk factors only have modest predictive value for identifying the high risk patients who sustain events (c-indexes approximately 0.6). The systematic review by Caldeira et al115 reported that the sensitivity, speci city and diagnostic ORs were, comparing HAS-BLED with ATRIA, sensitivity, speci city, and diagnostic ORs were, respectively, 0.41 (95% CI, 0.35- ATRIA. They concluded that HAS-BLED, due to its sensitivity (compared with other scores) and ease to apply, is recommended for the assessment of AF patients major bleeding risk. The systematic review by Zhu et al106 (11 studies) found that discrimination analysis demonstrates that HAS- BLED has no signi cant C-statistic differences for predicting bleeding risk in the low (RR, 1.16; 95% CI, 0.63-2.13; P .64) risk strati cation but underpredicts risk in the moderate (RR, 0.66; 95% CI, 0.51-0.86; P risk strata (e-Table 11). Zhu et al106 concluded that the HAS-BLED score performed better than the HEMORR2HAGES and ATRIA bleeding scores but was superior to the CHADS2 and CHA2DS2-VASc stroke scores for bleeding prediction. In a real-world AF cohort, there was no long-term advantage of the ABC- bleeding score over the HAS-BLED score, for predicting bleeding; in contrast, HAS-BLED was better in identifying those patients at low risk of bleeding.113 Given that the patient pathway may include AF patients initially on no antithrombotic therapy, aspirin, or anticoagulants, and the latter can include VKAs or NOACs, a bleeding risk score needs to be applicable throughout the patient pathway. 