Information 1,–3

  • CHA2DS2-VA is a tool that evaluates the risk of stroke in patients with Atrial fibrillation:
    • Congestive heart failure
    • Hypertension
    • Aged ≥ 75 years
    • Diabetes mellitus
    • Previous Stroke
    • Vascular disease
    • Aged 65–74 years

1. Calculator

Table 1. CHA2DS2-VASc calculator 1–3

Risk factor

Score

Congestive heart failure

  • Signs/symptoms of heart failure or objective evidence of reduced left ventricular ejection fraction

1

Hypertension

  • Resting blood pressure > 140/90 mmHg on ≥ 2 occasions OR current antihypertensive pharmacological treatment

1

Aged ≥ 75 years

2

Diabetes mellitus

  • Fasting glucose > 7 mmol/L (> 125 mg/dL) OR treatment with oral hypoglycaemic agent and/or insulin

1

Stroke

  • Any history of stroke, transient ischaemic attack, or thromboembolism

2

Vascular disease

  • Previous MI, peripheral artery disease, or aortic plaque

1

Aged 65–74 years

1

Scoring

  • Score ≥ 2 (men) or ≥ 3 (women) oral anticoagulation is recommended for those with N-VAF
  • Score 1 (men) or 2 (women) consider oral anticoagulation for those with N-VAF
  • Score 0 (no clinical risk factors) anticoagulation (or antiplatelet medicine) not recommended for those with N-VAF

2. Considerations 1–3

  • Low-risk patients who are not anticoagulated should be re-evaluated using the CHA2DS2-VA score annually
  • Stroke risk factors may change over time due to aging or development of new comorbidities
  • Assessment of bleeding using HAS-BLED  and other risks should continue throughout treatment
  • Educate all patients of the risks and benefits associated with anticoagulant medicines, so they can contribute to management decisions
  • Favour non-vitamin K oral anticoagulants (NOACs; dabigatran, rivaroxaban, apixaban) over warfarin as they are:
    • as good as or better in reducing stroke and systemic embolism
    • have a lower risk of intracranial haemorrhage as a side effect
    • easier for patients and clinicians to manage and use
  • If a patient is already on warfarin it is reasonable to change to a NOAC
  • Antiplatelet therapy is not recommended for stroke prevention regardless of stroke risk

3. References

Last updated: September 2024

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