CHA2DS2-VASc Score

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Clinical Use

Assess risk of stroke in atrial fibrillation to guide anticoagulation therapy

More Info

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

 

CHA2DS2-VASc Scoring
ConditionPoints
CCongestive heart failure (or Left ventricular systolic dysfunction)
1
HHypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)
1
A2Age ≥75 years
2
DDiabetes Mellitus
1
S2Prior Stroke or TIA or thromboembolism
2
VVascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
1
AAge 65–74 years
1
ScSex category (i.e. female sex)
1

 

Annual Stroke Risk
CHA2DS2-VASc ScoreStroke Risk %
0
0
1
1.3
2
2.2
3
3.2
4
4.0
5
6.7
6
9.8
7
9.6
8
12.5
9
15.2

Reference Values

Antithrombotic Therapy for Patients with Atrial Fibrillation3

CHA2DS2-VAScRecommended Therapy Based on Total Score Above
0No therapy preferred
1Aspirin, 81 to 325 mg daily, or oral anticoagulant (INR 2.0 to 3.0, target 2.5) **
≥ 2Oral 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.

References

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