Directions

Check the appropriate boxes to obtain a total CHA2DS2 - VASc risk score. See below for antithrombotic therapy recommendations. CHA2DS2 - VASc risk scores are valid for patients with either paroxysmal or persistent AF.

CHA2DS2 - VASc Risk Criteria

  C     1
             
  H     1
             
  A2     2
             
  D     1
             
  S2     2
             
  V     1
             
  A     1
             
  Sc     1
             
      Total Score   0

About CHA2DS2 - VASc

The CHA2DS2-VASc score can be considered an extension of the CHADS2 schema by considering additional stroke risk factors that may influence a decision whether or not to anticoagulate.

CHADS stands for Congestive heart failure, Hypertension, Age ( ≥ 65 = 1 point, ≥ 75 = 2 points), Diabetes, and Stroke/TIA (2 points). VASc stands for vascular disease (peripheral arterial disease, previous MI, aortic atheroma) and female gender is also included in this scoring system.

CHA2DS2-VASc allows health care professionals to quickly assess, interpret and explain to patients their stroke risk and the recommended therapy. Each risk factor receives 1 point except age ≥ 75 and stroke/TIA which receive 2 points. The more points on the CHA2DS2-VASc score, the higher the annual stroke risk in general.

Antithrombotic Therapy for AF Patients

Risk Category Recommended Therapy Based on Total Score Above
CHA2DS2 - VASc = 0 No therapy preferred
CHA2DS2 - VASc = 1 Aspirin, 81 to 325 mg daily, or oral anticoagulant (INR 2.0 to 3.0, target 2.5) **
CHA2DS2 - VASc ≥ 2 Oral anticoagulant (INR 2.0 to 3.0, 2 target 2.5) **

* No therapy is acceptable for patients < 65 years old and no heart disease (lone AF).

** If warfarin is the oral anticoagulant used, INR should be 2.0 to 3.0, with a target of 2.5. INR < 2.0 is not effective at preventing strokes. If mechanical valve, target INR = 2.5.

2011 ACCF/AHA/HRS focused updates incoporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with the atrial fibrillation:a report of the American College of Cardiology Foundation/American Heart Assocciation Task Force on Practice Guidelines developed in patnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2011 Mar 15; 57(11):e101-98