CHA₂DS₂-VASc Score

The CHA₂DS₂-VASc score is a clinical prediction tool used to estimate the risk of stroke in patients with non-valvular atrial fibrillation (AF). Healthcare providers use this scoring system to guide decision-making regarding anticoagulation therapy, with the goal of reducing stroke risk while balancing the risk of bleeding. The score has been widely adopted in clinical practice due to its efficacy in predicting stroke risk and guiding appropriate antithrombotic therapy.

The CHA₂DS₂-VASc score is calculated by assigning points to various stroke risk factors as follows:

• Congestive Heart Failure (CHF): 1 point
• Hypertension: 1 point
• Age 65-74 years: 1 point; Age ≥ 75 years: 2 points
• Diabetes Mellitus: 1 point
• Previous Stroke, Transient Ischemic Attack (TIA), or Thromboembolism: 2 points
• Vascular Disease (e.g., peripheral artery disease, myocardial infarction, or aortic plaque): 1 point
• Sex Category (female): 1 point

The total score ranges from 0 to 9, with higher scores indicating a higher risk of stroke.

The CHA₂DS₂-VASc score is used to determine the need for oral anticoagulation therapy in patients with non-valvular AF. The following recommendations are based on the score:

• CHA₂DS₂-VASc score of 0: Generally, no antithrombotic therapy is required.
• CHA₂DS₂-VASc score of 1: The decision to use anticoagulation therapy is based on an individualized assessment of the patient's stroke risk and bleeding risk.
• CHA₂DS₂-VASc score of 2 or higher: Oral anticoagulation therapy is recommended, with a preference for Direct oral anticoagulants (DOACs) over warfarin, unless contraindicated.

The CHA₂DS₂-VASc score is an essential tool for healthcare providers in estimating stroke risk and guiding anticoagulation therapy in patients with non-valvular AF. It is crucial to consider both stroke and bleeding risks when making treatment decisions.

References:

• Lip, G. Y., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. (2010). 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, 137(2), 263-272.