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Assess risk of stroke in atrial fibrillation to guide anticoagulation therapy
The CHA2DS2-VASc score is a simple stroke risk stratification schema, based on a risk factor approach. It provides some improvement in predictive value for thromboembolism over the original CHADS2 schema.
The CHA2DS2-VASc score better identifies low-risk subjects with low event rates and classifies only a small proportion of subjects into the intermediate-risk category. This schema improves the approach to stroke risk stratification in patients with atrial fibrillation.1, 2
|C||Congestive heart failure (or Left ventricular systolic dysfunction)|
|H||Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)|
|A2||Age ≥75 years|
|S2||Prior Stroke or TIA or thromboembolism|
|V||Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)|
|A||Age 65–74 years|
|Sc||Sex category (i.e. female sex)|
Annual Stroke Risk
|CHA2DS2-VASc Score||Stroke Risk %|
Antithrombotic Therapy for Patients with Atrial Fibrillation3
|CHA2DS2-VASc||Recommended Therapy Based on Total Score Above|
|0||No therapy preferred|
|1||Aspirin, 81 to 325 mg daily, or oral anticoagulant (INR 2.0 to 3.0, target 2.5) **|
|≥ 2||Oral anticoagulant (INR 2.0 to 3.0, 2 target 2.5) **|
** If warfarin is the oral anticoagulant used, INR should be 2.0 to 3.0, with a target of 2.5. INR < 2.0 is not effective at preventing strokes.
|1.||Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72. Full text|
|2.||Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010;41(12):2731-8. Full text|
|3.||Fuster V et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Full text|
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Developer: Sirikarn Napan, MD, FACC