CHA2DS2-VASc score for stroke risk in atrial fibrillation (AF)

To complement the CHADS2 score, by the inclusion of additional 'stroke risk modifier' risk factors, the CHA2DS2-VASc score was developed (1)

• these additional 'clinically relevant non-major' stroke risk factors include age 65-74, female gender and vascular disease
  
• in the CHA2DS2-VASc score score, 'age 75 and above' also has extra weight, with 2 points
  
• in clinical use, the CHADS2 score has been superseded by the CHA2DS2-VASc score, which gives a better stratification of low-risk patients
  

CHA2DS2-VASc score for stroke risk in atrial fibrillation

NICE suggest (2):

• use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with any of the following:
  • symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation
  • atrial flutter
  • a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm
• do not offer stroke prevention therapy to people aged under 65 years with atrial fibrillation and no risk factors other than their sex (that is, very low risk of stroke equating to a CHA2DS2-VASc score of 0 for men or 1 for women)
  
  
• anticoagulation based on CHA2DS2-VASc score
  • anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist
    
    
    • consider anticoagulation for men with a CHA2DS2-VASc score of 1. Take the bleeding risk into account
      
      
    • offer anticoagulation to people with a CHA2DS2-VASc score of 2 or above, taking bleeding risk into account
      
      
    • discuss the options for anticoagulation with the person and base the choice on their clinical features and preferences

Reference:

1. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72.
2. NICE. Atrial fibrillation: diagnosis and management. NICE guideline NG196. Published April 2021, last updated June 2021