Assessing Hemorrhagic Risk after Revascularization in Acute Ischemic Stroke: The Role of the HAS-BLED Score
Jose De Los Santos1, Deyrha Jennifer Mills1, Stephanie Castro Turbi1, Edwina Luna RodrÃguez1, Diego Gil Troncoso1
1CEDIMAT
Objective:
Evaluating the predictive value of the HAS-BLED score for hemorrhagic transformation in patients with acute ischemic stroke (AIS) undergoing revascularization therapies.
Background:
Hemorrhagic transformation, a common complication after reperfusion in AIS, limits therapeutic benefit and worsens outcomes. Although several predictive models exist, none are routinely used in practice. The HAS-BLED score, which estimates bleeding risk in atrial fibrillation, incorporates variables relevant to AIS and may help predict hemorrhagic risk after revascularization.
Design/Methods:
Retrospective observational study of AIS patients treated with reperfusion therapies at a Dominican stroke unit (January 2024-June 2025). Data from the Res-Q registry and electronic medical records were used to compute the HAS-BLED score. A multivariable binary logistic regression model was built using SPSS version 31, including age ≥80 years old, NIHSS ≥10, wake-up stroke, and revascularization procedure as covariates.
Results:
A total 294 AIS patients were analyzed; 20.1% (n=59) underwent reperfusion therapy (49.2% [n=29] thrombolysis, 33.9% [n=20] thrombectomy, and 16.9% [n=10] both). Half were male, 30.5% had hypertension. Median age was 75 years (IQR 16), and median NIHSS was 10 (IQR 10). Hemorrhagic transformation occurred in 40.7% (n=24). Median HAS-BLED was 2 (IQR 2). In multivariable analysis, HAS-BLED ≥3 was associated with higher odds of hemorrhagic transformation (aOR 2.19; 95% CI 0.59–8.10; p= 0.24), though not significant. Age ≥80 was independently protective (aOR 0.22; 95% CI 0.06–0.84; p= 0.027), and NIHSS >10 showed a borderline association with increased risk (aOR 3.52; 95% CI 0.91–13.62; p = 0.068). Revascularization type and wake-up stroke were not significant predictors.
Conclusions:
The HAS-BLED score did not reliably predict hemorrhagic transformation after reperfusion in AIS. Although higher scores showed a nonsignificant trend toward increased risk, the model lacked discriminatory value. Age and baseline stroke severity were stronger predictors. These findings suggest that HAS-BLED is not an adequate tool for estimating post-revascularization hemorrhagic risk in this population.
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