ADD-ONS / SCALES AND SCORES

CHA2DS2-VASc score

Created 20.9.2019 , last update 05.11.2021

  • CHA2DS2-VASc score helps to estimate the annual risk of a thromboembolic event in non-anticoagulated patients with non-valvular atrial fibrillation(AFib)
    • patients with paroxysmal atrial fibrillation have a similar risk of stroke as patients with persistent or permanent forms [Hart 2000]
  • annual stroke risk predetermined the choice of prophylactic medication → for initial assessment of the risk of thromboembolic complications, the CHA2DS2-VASc score is recommended instead of the older CHADS2 score
  • low-risk patients with a CHA2DS2-VASc score of 0 (male) or 1 (female) need no antithrombotic therapy
  • oral anticoagulant therapy should be offered to those with ≥1 additional stroke risk factor. In secondary stroke prevention, patients have ≥ 2 points and automatically should receive anticoagulant therapy.
CHA2DS2-VASc score and CHADS2 score
CHA2DS2-VASc score
CHADS2 score
C – CHF (Congetive Heart Failure) history (EF<40%)
1
1
H – hypertension history
1
1
A – age ≥ 75
2
1
D – diabetes history
1
1
S2 – stroke/TIA/thromboembolism history
2
2
V – vascular disease history (prior MI, PAD, or aortic / carotid plaque)
1
A – age 65-74 let
1
Sc (sex category)
1 (female)
CHA2DS2-VASc CHADS2
Annual stroke risk
[Eckmann,2011]
Annual stroke risk
Gage, JAMA 2001]
0 – 0%
1 – 1.35% **
2 – 2.2%
3 – 3.2%
4 – 4.0%
5 – 6.7%
6 – 9.8%
7 – 9.6%
8 – 6.7%
9 – 15.2%
0 – 1.9%
1 – 2.8%
2 – 4.0%
3 – 5.9%
4 – 8.5%
5 – 12.5%
6 – 18.2%

** according to some reports the risk of CHA2DS2-VASc score is lower – 0.2-0.7%   [Friberg, 2015]

  • a limitation of both scales lies in the absence of some critical information:
    • TEE – spontaneous echo contrast or thrombus in the left atrium?
    • brain CT / MRI  – silent ischemias ? microhemorrhages on GRE?
    • assessment of individual bleeding risk (especially intracranial)
  • besides, scales are based on data from patients taking warfarin – lower risk of bleeding can be assumed for DOACs
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