CHA₂DS₂-VASc Score: Explanation and Clinical Context The CHA₂DS₂-VASc Score is a validated clinical risk stratification tool used to estimate the annual risk of ischemic stroke in patients with atrial fibrillation (AF), particularly non-valvular AF. It refines the earlier CHADS₂ Score by incorporating additional risk factors—vascular disease, age 65–74 years, and female sex—to improve sensitivity in identifying patients at truly low risk who may still benefit from anticoagulation.
Each clinical variable contributes to the overall score: Congestive heart failure (1), Hypertension (1), Age ≥75 years (2), Diabetes mellitus (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 years (1), and Female sex (1). The maximum score is 9.
Patients with higher scores have proportionally greater annual stroke risks, ranging from less than 1% in low-risk patients to more than 15% in those with multiple risk factors. A score of ≥2 in men or ≥3 in women generally warrants oral anticoagulation (DOACs or vitamin K antagonists), whereas lower scores may be managed with careful observation or antiplatelet therapy depending on comorbidities and bleeding risk.
This score is widely endorsed by the European Society of Cardiology (ESC) and the American Heart Association (AHA/ACC/HRS) for guiding antithrombotic therapy in atrial fibrillation management.
Reference:
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. *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;137(2):263–272.
Hindricks G, et al. *2020 ESC Guidelines for the diagnosis and management of atrial fibrillation.* Eur Heart J. 2021;42(5):373–498.
January CT, et al. *2019 AHA/ACC/HRS Focused Update on Atrial Fibrillation.* Circulation. 2019;140:e125–e151.