CHA2DS2-VASc (FA risco AVC)

CHA2DS2-VASc: stroke risk in atrial fibrillation

The CHA2DS2-VASc estimates yearly stroke risk in patients with non-valvular atrial fibrillation, and that estimate is what tells you whether oral anticoagulation is worth starting. Each letter carries points: Congestive heart failure (1), Hypertension (1), Age ≥75 (2), Diabetes (1), Stroke/TIA/thromboembolism prior (2), Vascular disease — MI, PAD, aortic plaque (1), Age 65–74 (1), Sex category female (1). Totals run from 0–9. The decision threshold is ≥2 in men or ≥3 in women: anticoagulate (DOAC preferred, or warfarin); a score of 0 (man) / 1 (woman, sex point only): do not anticoagulate. Example: a 70-year-old man with hypertension and diabetes scores 1+1+1 = 3, so anticoagulation is indicated.

Clinical context

The ESC, AHA/ACC and the Brazilian Society of Cardiology (SBC) all point to it as the standard way to stratify thromboembolic risk in AF. It took over from the older CHADS2 once vascular disease, sex and a wider age range were folded in. You will see it in cardiology clinics, in primary prevention, when weighing a DOAC against warfarin, and in the day-to-day management of older patients with AF. Because the number shifts as people age and pick up new comorbidities, it is worth recalculating from time to time.

FAQ

Does female sex alone justify anticoagulation? No. A woman with the sex point and nothing else (total = 1) does not need anticoagulation. Current guidance is to start counting from ≥2 additional points in women.

Does it apply to valvular AF? No. With mitral stenosis or a mechanical valve, anticoagulation is required whatever the score says.

Why score 2 points for prior stroke? A previous TIA or stroke is the strongest single predictor of another one, and it roughly doubles the absolute annual risk, so it carries double weight.

Should I combine with HAS-BLED? Yes. CHA2DS2-VASc tells you how much anticoagulation stands to help, while HAS-BLED flags the bleeding risk you need to keep an eye on. On its own, HAS-BLED is not a reason to withhold treatment.