How can physicians use the HAS-BLED score in practice, given the degree of overlap with the risk factors for ischemic stroke, which literally are paralleling and mirroring the risk factors for bleeding?  This is really the dilemma.  

Figure 11 references an extract from the consensus statement from the European Heart Rhythm Association (EHRA) endorsed by the European Society of Cardiology (ESC).[9]  This states that most patients with a high CHA₂DS₂-VASc stroke-risk score will benefit from oral anticoagulant therapy, even if their bleeding risk is high.  Only in the rare patient with a relatively low stroke risk and in an extremely increased risk of bleeding may the withholding of therapy be considered.