The Complete Guide to CHA₂DS₂-VASc Score

Master the CHA₂DS₂-VASc score for atrial fibrillation stroke risk stratification. Learn when to anticoagulate and how to apply evidence-based guidelines.

What is the CHA₂DS₂-VASc Score?

The CHA₂DS₂-VASc score is the gold standard for assessing stroke risk in patients with non-valvular atrial fibrillation. It guides anticoagulation decisions and has largely replaced the older CHADS₂ score.

Scoring Components

FactorPoints
C - Congestive heart failure1
H - Hypertension1
A₂ - Age ≥75 years2
D - Diabetes mellitus1
S₂ - Stroke/TIA/thromboembolism2
V - Vascular disease1
A - Age 65-74 years1
Sc - Sex category (female)1

Interpretation

  • Score 0 (male) or 1 (female): Low risk - No anticoagulation needed
  • Score 1 (male): Consider anticoagulation
  • Score ≥2: Anticoagulation recommended

Clinical Pearls

  1. Always calculate HAS-BLED alongside CHA₂DS₂-VASc
  2. Female sex only adds a point if other risk factors present
  3. DOACs are preferred over warfarin in most patients
  4. Score applies to non-valvular AF only

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