About CHA₂DS₂-VASc
The CHA₂DS₂-VASc score quantifies stroke risk in patients with non-valvular atrial fibrillation to guide anticoagulation decisions. Introduced by Lip et al. in 2010 as a refinement of the original CHADS₂ score, it adds vascular disease, age 65–74, and sex category to improve risk stratification in low-risk patients.
Acronym Breakdown
| Letter | Risk Factor | Points |
|---|---|---|
| C | Congestive heart failure / LV dysfunction | 1 |
| H | Hypertension | 1 |
| A₂ | Age ≥75 years | 2 |
| D | Diabetes mellitus | 1 |
| S₂ | Stroke / TIA / thromboembolism history | 2 |
| V | Vascular disease (MI, PAD, aortic plaque) | 1 |
| A | Age 65–74 years | 1 |
| Sc | Sex category (female) | 1 |
Annual Stroke Risk by Score
| Score | Annual Stroke Risk | Recommendation |
|---|---|---|
| 0 | 0.0% | No anticoagulation |
| 1 | 1.3% | Consider OAC (especially if not female sex alone) |
| 2 | 2.2% | Oral anticoagulation recommended |
| 3 | 3.2% | Oral anticoagulation recommended |
| 4 | 4.0% | Oral anticoagulation recommended |
| 5 | 6.7% | Oral anticoagulation recommended |
| 6 | 9.8% | Oral anticoagulation recommended |
| 7 | 9.6% | Oral anticoagulation recommended |
| 8 | 6.7% | Oral anticoagulation recommended |
| 9 | 15.2% | Oral anticoagulation recommended |
Note on Female Sex
Female sex alone (CHA₂DS₂-VASc = 1 in a patient with no other risk factors) is not considered a net benefit indication for anticoagulation. The 2023 AHA/ACC guidelines clarify that female sex is a risk modifier, not an independent risk factor. Anticoagulation should be considered when there is ≥1 additional non-sex-based risk factor.
References
Lip GYH, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest. 2010;137(2):263–272.
Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation. J Am Coll Cardiol. 2024;83(1):109–279.