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 | |
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
- 1. Kirchhof P, Benussi S, Kotecha D et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal (2016) 37, 2893–2962. doi: https://doi.org/10.1093/eurheartj/ehw210.
- 2. January CT, Wann LS, Calkins Het al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2019;0. doi: https://doi.org/10.1161/CIR.0000000000000665.
