Evaluating the Use of Warfarin Using the HAS-BLED Score and INR on Atrial Fibrillation Patients at Harapan Kita National Heart Center


  • Meva Sari Chandra Universitas Pancasila
  • Shirly Kumala Universitas Pancasila
  • Sesilia Andriani Keban Universitas Pancasila




Atrial Fibrillation, Warfarin, INR (International Normalized Ratio), HAS-BLED


Patients with atrial fibrillation are associated with a 4-5-fold risk of having a stroke. The most effective treatment for atrial fibrillation is to prevent the formation of blood clots by administering anticoagulant drugs. Warfarin is an anticoagulant drug that has a narrow therapeutic index with side effects of the risk of bleeding; hence it needs supervision in its use. In this study, the HAS-BLED score was used to measure major bleeding risk and as a value representing each risk factor for bleeding. The bleeding risk can be prevented by maintaining a warfarin response in the therapeutic range with an INR (International Normalized Ratio) measurement 2-3. This study was an observational study conducted with retrospective data collection through medical records of patients with a primary diagnosis of atrial fibrillation who received oral warfarin anticoagulant therapy at Harapan Kita National Heart Center in the period of January-December 2017. Using a sample of 40 patients who met the inclusion criteria. According to the data, found that atrial fibrillation patients who received oral warfarin therapy 55% were male patients, while 45% were female patients. Patients with atrial fibrillation who got the most oral warfarin therapy were patients who were over 40 years old with 90% of the total sample, with the highest group in patients aged 50-54 years with 22.5%. The HAS-BLED values arranged from 0-9, the percentage of patients who had HAS-BLED values of 0, 1, 2 respectively at 7.5%, 42.5%, 30%. The HAS-BLED score ≥ 3 showed patients classified as at high risk of bleeding by 20%. The most risk factors based on HAS-BLED score from all study samples were 18 patients with abnormal kidney or 45%. The average INR score in patients at high risk of bleeding showed that 37.5% had an average INR score in the target ratio score of INR 2-3.

Author Biographies

Meva Sari Chandra, Universitas Pancasila

Fakultas Farmasi

Shirly Kumala, Universitas Pancasila

Fakultas Farmasi

Sesilia Andriani Keban, Universitas Pancasila

Fakultas Farmasi


[1] Alan S, Elaine M, Kathleen A. National implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA. 2001;285(18):2370-75.

[2]Faradina N, Fadilah N, Budi SC, Iii D, Medis R, Vokasi S. Efektifitas Implementasi Clinical Pathway Terhadap Average Length Of Stay dan Outcomes Pasien DF-DHF Anak di RSUD Kota Yogyakarta. Jkesvo (Jurnal Kesehatan Vokasional). 2017;2(2):175–81.

[3] PERKI. Pedoman Tata Laksana Fibrilasi Atrium. Jakarta: Penerbit Centra Communications; 2014.

[4] Hughes M, Lip G. Stroke and thromboembolism in atrial fibrillation. J Thromb Haemost. 2008;99(02):295-04.

[5] Thomas A, Robert P. Which patients with atrial fibrillation should receive anticoagulation. American College of Cardiology & Medscape. 2018.

[6] Hart R, Aguilar M, Pearce L. Meta-analysis : Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857-67.

[7] Blann A, Landray M, and Lip G. ABC of antithrombotic therapy: An overview of antithrombotic therapy. BMJ. 2002;325(7367) : 762–65.

[8] World Health Organization. Age standardization of rates: a new who standard 2001.

[9] Smeltzer, Bare. Buku Ajar Keperawatan Medikal Bedah Brunner dan Suddart. Penerbit Buku Kedokteran ECG. Jakarta. 2002. Hal 35-43.




How to Cite

Chandra, M. S., Kumala, S., & Keban, S. A. (2020). Evaluating the Use of Warfarin Using the HAS-BLED Score and INR on Atrial Fibrillation Patients at Harapan Kita National Heart Center. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 14(2). https://doi.org/10.33533/jpm.v14i2.1671