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CHA2DS2-VASc Score


The introduction of the CHA2DS2-VASc score has simplified the initial decision for oral anticoagulation in atrial fibrillation patients.

In patients with atrial fibrillation (AF) or atrial flutter, the CHA2DS2-VASc score is recommended by AHA/ACC/HRS and ESC Guidelines for assessment of stroke risk 1 2.

In every patient with AF, irrespective of whether the AF pattern is paroxysmal, persistent, or permanent, risk of stroke should be calculated in order to decide the necessity of anticoagulant therapy 1 2.

CHA2DS2-VASc Score


Points

Congestive heart failure or ejection fraction ≤35%

1

Hypertension (high blood pressure)

1

Age:

Under 65 years

0

65 to 74 years

1

75 years or older

2

Diabetes mellitus

1

Stroke, TIA or systemic thromboembolism history

2

Peripheral arterial disease, myocardial infarction or aortic plaque

1

Sex category: female sex

1

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Stroke Risk

  • Men

  • CHA2DS2-VASc score of 0: Low risk. It is reasonable to omit anticoagulant therapy.
  • CHA2DS2-VASc score of 1: Low-moderate risk. Oral anticoagulant may be considered.
  • CHA2DS2-VASc score of 2 or greater: Moderate-high risk. Anticoagulation, except contraindications.
  • Women

  • CHA2DS2-VASc score of 0-1: Low Risk. It is reasonable to omit anticoagulant therapy.
  • CHA2DS2-VASc score of 2: Low-moderate Risk. Oral anticoagulant may be considered.
  • CHA2DS2-VASc score of 3 or greater: Moderate-high Risk. Anticoagulation, except contraindications.

Is Oral Anticoagulation Recommended?

Patientes with atrial fibrillation or atrial flutter and CHA2DS2-VASc score of 2 or greater in men or 3 or greater in women oral anticoagulants are recommended 1 2.

The decision of administering anticoagulants to the patient is irrespective of the atrial fibrillation pattern suffered by the patient; both paroxysmal and permanent AF present the same stroke risk.

Patients with a CHA2DS2-VASc score of 1 in men and 2 in women, prescribing an oral anticoagulant to reduce thromboembolic stroke risk may be considered 1 2.

It is reasonable to omit anticoagulant therapy in patients with no risk factors (CHA2DS2-VASc score of 0 in men or 1 in women).

References


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