Scoring System Archives - almostadoctor https://almostadoctor.co.uk/encyclopedia/tag/scoring-system medical encyclopaedia and OSCE guide Thu, 29 Oct 2020 20:33:16 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 https://almostadoctor.co.uk/wp-content/uploads/2017/05/cropped-Icon-32x32.png Scoring System Archives - almostadoctor https://almostadoctor.co.uk/encyclopedia/tag/scoring-system 32 32 CHADS2 and CHA2DS2-VASc Scores https://almostadoctor.co.uk/encyclopedia/chads2-score https://almostadoctor.co.uk/encyclopedia/chads2-score#respond Tue, 13 Jun 2017 06:09:49 +0000 http://almostadoctor.co.uk/?post_type=encyclopedia&p=530 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 Generally in clinical use, the CHA2DS2-VASc has superseded use of the CHADS2 score, which has been criticised for underestimating stroke risk in some patients.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 […]

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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 Generally in clinical use, the CHA2DS2-VASc has superseded use of the CHADS2 score, which has been criticised for underestimating stroke risk in some patients.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

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

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