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CHA₂DS₂-VASc

Stroke risk stratification in non-valvular atrial fibrillation

Indication

  • Stroke risk stratification in non-valvular atrial fibrillation

Criteria

  • id: chf; label: CHF / LV dysfunction; type: yesno; points: 1
  • id: htn; label: Hypertension; type: yesno; points: 1
  • id: age75; label: Age ≥ 75; type: yesno; points: 2
  • id: dm; label: Diabetes mellitus; type: yesno; points: 1
  • id: stroke; label: Prior stroke/TIA/thromboembolism; type: yesno; points: 2
  • id: vasc; label: Vascular disease (prior MI, PAD, aortic plaque); type: yesno; points: 1
  • id: age65; label: Age 65-74; type: yesno; points: 1
  • id: female; label: Female sex; type: yesno; points: 1

Interpretation

  • function(score) { if (score === 0) return { risk: score + '/9', tier: 'Low Risk', action: 'Annual stroke risk 0%. No anticoagulation needed.', color: 'green' }; if (score === 1) return { risk: score + '/9', tier: 'Low-Moderate', action: 'Annual stroke risk ~1.3%. Consider anticoagulation (especially if male with score 1).', color: 'yellow' }; return { risk: score + '/9', tier: 'Moderate-High Risk', action: 'Annual stroke risk ' + (score >= 6 ? '≥10' : score >= 4 ? '4-7' : '2-3') + '%. Anticoagulation recommended.', color: 'red' }; }

Clinical pearls

  • Score 0 (male) or 1 (female from sex point alone): no anticoagulation
  • Score ≥2 (male) or ≥3 (female): anticoagulation recommended
  • DOACs preferred over warfarin in most patients (RELY, ROCKET-AF, ARISTOTLE)
  • Female sex alone (score 1 in female) does not warrant anticoagulation

Source and review

  • Lip et al., Chest 2010; ESC AF Guidelines 2020. Last reviewed: 2024-10-15