CHA2DS2-VASc score for stroke risk in atrial fibrillation (AF)
Last edited 05/2018 and last reviewed 08/2023
To complement the CHADS2 score, by the inclusion of additional 'stroke risk modifier' risk factors, the CHA2DS2-VASc score was developed (1)
- these additional 'clinically relevant non-major' stroke risk factors include
age 65-74, female gender and vascular disease
- in the CHA2DS2-VASc score score, 'age 75 and above' also has extra weight,
with 2 points
- in clinical use, the CHADS2 score has been superseded by the CHA2DS2-VASc
score, which gives a better stratification of low-risk patients
CHA2DS2-VASc score for stroke risk in atrial fibrillation
| Feature | Score |
| Congestive Heart Failure | 1 |
| Hypertension | 1 |
| Age >75 years | 2 |
| Age between 65 and 74 years | 1 |
| Stroke/TIA/TE | 2 |
| Vascular disease (previous MI, peripheral arterial disease or aortic plaque) | 1 |
| Diabetes mellitus | 1 |
| Female | 1 |
NICE suggest (2):
- use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with
any of the following:
- symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation
- atrial flutter
- a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm
- do not offer stroke prevention therapy to people aged under 65 years
with atrial fibrillation and no risk factors other than their sex (that is,
very low risk of stroke equating to a CHA2DS2-VASc score of 0 for men or 1
for women)
-
anticoagulation based on CHA2DS2-VASc score
- anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban
or a vitamin K antagonist
- consider anticoagulation for men with a CHA2DS2-VASc score of
1. Take the bleeding risk into account
- offer anticoagulation to people with a CHA2DS2-VASc score of
2 or above, taking bleeding risk into account
- discuss the options for anticoagulation with the person and base the choice on their clinical features and preferences
- consider anticoagulation for men with a CHA2DS2-VASc score of
1. Take the bleeding risk into account
- anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban
or a vitamin K antagonist
Reference:
- 1) Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. 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 Feb;137(2):263-72.
- 2) NICE (June 2014). Atrial fibrillation: the management of atrial fibrillation