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CHA2DS2 -VASC SCORE

The CHA2DS2-VASc score is a modification of the CHADS2


score that aims to improve stroke risk prediction in patients
with atrial fibrillation (AF) by adding three risk factors: age
6574, female sex, and history of vascular disease

Such a score is used to determine whether or not treatment is required


with anticoagulation therapy or antiplatelet therapy
Atrial fibrilation (AF) is a cardiac arrhythmia with the
potential to cause thromboembolism. Studies suggest that
AF increases the risk of stroke five-fold

Thus, it is important to determine which patients with AF


may benefit from oral anticoagulant (OAC) and possibly
aspirin therapy to reduce the risk of stroke.
First published in 2001, the CHADS2 score (congestive heart failure,
hypertension, age 75 years, diabetes mellitus, stroke was developed to more
accurately predict the risk of stroke in patients with nonrheumatic AF

The 2016 European Society of Cardiology (ESC) guidelines recommend using


the CHA2DS2-VASc score to estimate stroke risk in AF patients and to start
OACs in men with a score of 1 or higher and women with a score of 2 or
higher.

The 2014 American Heart Association/ American College of Cardiology/ Heart


Rhythm Society guidelines also recommend the CHA2DS2-VASc score for the
assessment of stroke risk in paitents with nonvalvular AF. Consideration of OAC
prophylaxis is recommended for patients with a score of 1 and OAC use is a
definite recommendation for patients with a score of 2 or greater and for those
with a history of stroke or transient ischemic attack
CHADS2 Risk Adjusted Stroke Risk
Score CHADS2 Score
Criteria (%)

Congestive 0 1.9
1 point
heart failure
1 2.8
1 point Hypertension
2 4
1 point Age 75 years
3 5.9
Diabetes
1 point 4 8.5
mellitus
Score CHA2DS2-VASc Risk Criteria

1 point Congestive heart failure

1 point Hypertension

2 points Age 75 years

1 point Diabetes mellitus

Stroke/Transient Ischemic
2 points
Attack/Thromboembolic event

Vascular disease (prior MI, PAD, or aortic


1 point
plaque)

1 point Age 65 to 74 years

1 point Sex category (ie, female sex)


CHA2DS2-VASc Score Adjusted Stroke Risk, (% per year)
0 0
1 1.3
2 2.2
3 3.2
4 4.0
5 6.7
6 9.8
7 9.6
8 6.7
9 15.2
CHA2DS2-VASc Score Recommendation

0 None

1 None or aspirin or OAC

2 or more OAC