What is CHA₂DS₂-VASc score?

CHA₂DS₂-VASc is a validated clinical prediction tool used to estimate the annual stroke risk in patients with atrial fibrillation. It helps guide decisions about anticoagulation therapy. The score ranges from 0-9 with higher scores indicating higher stroke risk.

When should anticoagulation be offered?

According to NICE NG196, anticoagulation should be offered to people with atrial fibrillation who have a CHA₂DS₂-VASc score of 2 or above. For males with a score of 1, anticoagulation should be considered after discussion of risks and benefits.

What anticoagulation options are available?

Direct Oral Anticoagulants (DOACs) such as apixaban, rivaroxaban, edoxaban, and dabigatran are preferred first-line options if suitable. Warfarin is an alternative if DOACs are contraindicated or not tolerated. The choice should be individualized based on patient factors, renal function, and bleeding risk.

Should bleeding risk be assessed?

Yes, bleeding risk should be assessed before initiating anticoagulation. Tools like ORBIT or HAS-BLED can be used. However, high bleeding risk is not an absolute contraindication - instead, modifiable risk factors should be addressed and patients should be monitored more closely.

What does each component of CHA₂DS₂-VASc mean?

C = Congestive heart failure (1 point), H = Hypertension (1 point), A₂ = Age ≥75 years (2 points), D = Diabetes (1 point), S₂ = Prior stroke/TIA/thromboembolism (2 points), V = Vascular disease (1 point), A = Age 65-74 years (1 point), Sc = Sex category female (1 point). Maximum score is 9 points.

CHA₂DS₂-VASc Calculator | Free AF Stroke Risk Tool

CHA₂DS₂-VASc Score

For patients with confirmed atrial fibrillation (AF) — guides anticoagulation decisions per NICE NG196.

Congestive heart failure / LVEF ≤40%

Hypertension (history or on treatment)

A₂ge ≥75 years

Diabetes mellitus

S₂troke / TIA / thromboembolism (previous)

Vascular disease (MI, PAD, aortic plaque)

Age 65–74 years

Sex category: Female

Risk Category

Recommendation (NICE NG196)

Anticoagulation Options

Bleeding risk: Consider ORBIT or HAS-BLED before initiating anticoagulation.

About

Validated stroke risk score for patients with AF. Guides oral anticoagulation per NICE NG196.

Use in: Paroxysmal, persistent, or permanent AF — at diagnosis and annual review.

Score Thresholds

0 ♂ / 1 ♀ — Low; anticoagulation not routinely indicated
1 ♂ — Moderate; consider anticoagulation
≥2 — High; offer anticoagulation

Key Considerations

Assess bleeding risk (ORBIT / HAS-BLED)
DOACs preferred over warfarin
Check renal function before DOAC
Shared decision-making with patient
Review anticoagulation annually

References

NICE NG196 — Atrial fibrillation Europace — Original validation Circulation — Clinical application

Recommendation (NICE NG196)

Anticoagulation Options

About

Score Thresholds

Key Considerations

References

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