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 Generally in clinical use, the CHA2DS2-VASc has superseded use of the CHADS2 score, which has been criticised for underestimating stroke risk in some patients.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
| C | CHF (congestive heart failure) or LVEF <40% | 1 |
| H | Hypertension | 1 |
| A2 | Age ≥75 | 2 |
| D | Diabetes | 1 |
| S2 | Previous stroke, TIA or thromboembolism | 2 |
| V | Vascular disease | 1 |
| A | Age 65-74 | 1 |
| Sc | Female | 1 |
CHADS2
| C | CHF or LVEF <40% | 1 |
| H | Hypertension | 1 |
| A | Age ≥75 | 2 |
| D | Diabetes | 1 |
| S2 | Previous stroke, TIA or thromboembolism | 2 |
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
|