CHADS2 and CHA2DS2-VASc Scores for Estimation of Stroke Risk in Patients with Atrial Fibrillation

The most well-known scores used in clinical practice to estimate the risk of stroke in patients with atrial fibrillation are the CHADS2 and its newer version, CHA2DS2-VASc

SCORES:

CHADS2 Score:

Criteria	Points to add
Congestive Heart Failure	+1
Hypertension	+1
Age >= 75 years	+1
Diabetes	+1
Prior stroke, TIA or PE	+2

CHA2ADS2-VASc Score:

Criteria	Points to add
Congestive Heart Failure	+1
Hypertension	+1
Age >= 75 years	+2
Diabetes	+1
Prior stroke, TIA or thromboembolism	+2
Vascular disease (such as PAD, aortic disease)	+1
Age between 65 and 74 years	+1
Sex category, if female	+1

SCORE RESULTS PREDICTION:

CHADS2 Score	Annual Stroke Risk (%)
0	1.9
1	2.8
2	4
3	5.9
4	8.5
5	12.5
6	18.2

CHA2DS2-VASc Score	Annual Stroke 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

ANTICOAGULATION ACCORDING TO SCORE RESULTS:

CHADS2 Score:
0 – Low risk – Consider aspirin (81-325mg) daily.
1 – Intermediate risk – Consider aspirin or Oral Anticoagulation
2 or more – High risk – Consider oral Anticoagulation

CHA2DS2-VASc Score:
0 (male) or 1 (female) – Low risk – No anticoagulant
1 (male) – Moderate risk – Consider anticoagulation
2 or greater – High risk – Oral anticoagulation recommended

It is also important to consider the risk of bleeding before starting anticoagulation on patients with atrial fibrillation. To assess the risk of major bleeding, one can use the HAS-BLED score.

REFERENCES & FURTHER READING: