CHADS2 and CHA2DS2-VASc Scores
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The CHADS2 and CHA2DS2-VASc (“Chads-Vasc”) scores are used for assessing the risk of stroke in AF. Generally in clinical use, the CHA2DS2-VASc has superseded use of the CHADS2 score, which has been criticised for underestimating stroke risk in some patients.
  • As such – it is much harder to score “0” on the Chads-Vasc score!

Generally, a score of 0 implies no need for anticoagulation, a score of 2 implies a need of anticoagulation, and a score of 1 indicates a “low-moderate” risk and anticoagulation “should be considered”.

  • Anticoagulation can either be in the form of warfarin, or a NOAC (New Oral Anticoagulant) – such as Rivaroxaban
  • A previous recommendation to use aspirin for those with a score of “1” is no longer recommended – as this does not provide sufficient anticoagulation to reduce stroke risk in these patients.

Some caveats to bear in mind are:

  • These scores are designed for use in patients without valvular heart disease – this includes the vast majority of patients with AF
  • Some patients may be deemed to be at high risk of bleeding and as such – anticoagulation may not be appropriate. Weighing up the pros and cons of anticoagulation is often done with a combination of the CHA2DS2-VASc score and the HAS-BLED score

CHA2DS2-VASc

CCHF (congestive heart failure) or LVEF <40%1
HHypertension1
A2Age ≥752
DDiabetes1
S2Previous stroke, TIA or thromboembolism2
VVascular disease1
AAge 65-741
ScFemale1

 

CHADS2

CCHF or LVEF <40%1
HHypertension1
AAge ≥752
DDiabetes1
S2Previous stroke, TIA or thromboembolism2

Interpretation

Score
Risk
Anticoagulation therapy
Considerations
0
Low
 None
1
Low-Moderate
Consider
If using warfarin – aim for INR 2.0 – 3.0
≥2
Moderate or High
Recommended
If using warfarin – aim for INR 2.0 – 3.0

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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