CHA2DS2VAScScore

The CHA2DS2-VASc score is a clinical prediction rule used to estimate the risk of stroke in adults with atrial fibrillation and to guide decisions about anticoagulation therapy. It is an extension of the CHADS2 score, adding additional risk factors to improve risk stratification for low- versus high-risk patients.

The score assigns points as follows: congestive heart failure or left ventricular dysfunction (1); hypertension (1); age 65–74 years (1); diabetes mellitus (1); vascular disease such as prior myocardial infarction or peripheral artery disease or aortic plaque (1); age 75 years or older (2); prior stroke, TIA, or thromboembolism (2); and female sex (1). The total ranges from 0 to 9.

In nonvalvular atrial fibrillation, higher scores correspond to higher estimated stroke risk and are used to guide anticoagulation decisions. Anticoagulation is commonly recommended for higher scores, with many guidelines suggesting therapy when the score equals or exceeds 2 in men or 3 in women, after considering bleeding risk and patient preferences. Choices include direct oral anticoagulants or vitamin K antagonists.

Limitations include its applicability mainly to nonvalvular AF, potential variation in risk estimates across populations, and the fact that female sex is treated as a risk modifier rather than an independent indication for anticoagulation. Bleeding risk assessment (for example, HAS-BLED) and overall clinical judgement should accompany the score in decision making.