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. The HAS-BLED score has been validated in AF patients from clinical trial and nontrial cohorts, whether on no antithrombotic therapy, aspirin or anticoagulants, VKA or non-VKA anticoagulants, and is predictive of bleeding in AF and non-AF cohorts, and in different ethnic groups.98,114,116 It is also the only bleeding score predictive of The HAS-BLED score has also been shown to be similar or outperform older bleeding scores, as well as more Patient with AF; Eligible for Oral Anticoagulation Bleeding risk assessment Identifies at risk patients for more regular review and follow-up A high risk bleeding risk score is not a reason or excuse to withhold OAC Low risk = No action High risk = Patient flagged up for review EHR and electronic alerts For patients with an increased risk of bleeding the bene t of OAC usually, but not always, outweighs the bleeding risk; thus, regular review and careful monitoring of bleeding risk is important Do not withhold OAC solely because the patient is at risk of falls - Uncontrolled hypertension - Labile INRs (if on VKA) - Concomitant use of aspirin and NSAIDs in anticoagulated patient - Alcohol excess Review and address potentially reversible bleeding risk factors Figure 3 Practical application of bleeding risk assessment in patients with AF. AF atrial brillation; EHR electronic health record. See Figure 1 and 2 legends for expansion of other abbreviations. 