The CHA₂DS₂-VASc score estimates annual stroke risk in patients with non-valvular atrial fibrillation and guides the decision to anticoagulate. It extends the older CHADS₂ score with additional risk factors (vascular disease, age 65–74, sex category).
High-yield: score 0 (men) / 1 (women, sex category alone) = low risk, no
anticoagulation. Score ≥2 in men or ≥3 in women = oral anticoagulation generally indicated.
The in-between scores (1 in men, 2 in women) are where judgment and shared decision-making live.
How to use it
Tick every risk factor that applies; the points sum automatically. Age counts once — use either ≥75 (2 points) or 65–74 (1 point), not both.
Don't miss: female sex is a risk modifier, not a standalone indication —
a woman whose only "risk factor" is her sex (score 1) is effectively low risk. And bleeding risk
runs in parallel: assess it (e.g. HAS-BLED) to fix modifiable bleeding factors, not to withhold
anticoagulation from a high-risk patient.
References
- Lip GY, Nieuwlaat R, Pisters R, et al. 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;137:263–272.
- Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J 2021;42:373–498.
Draft content — verify against the cited sources before relying on it.