C Congestive heart failure-score 1
H Hypertension -score 1
A Age ≥75 years -score 2
D Diabetes Mellitus -score 1
S2 Prior Stroke or TIA 2 -score 2
A clinical prediction rule for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation.
Used to determine whether or not treatment is required with anticoagulation therapy or antiplatelet therapy since AF leads to the formation of a mural thrombus that can reach the brain and cause a stroke.
C Congestive heart failre -score 1
H Hypertension -score 1
A Advanced age 75 years or> -score 2
D Diabetes -score 1
S2 Prior CVA or TIA -score 2
A high CHADS2 score corresponds to a greater risk of stroke, while a low CHADS2 score corresponds to a lower risk of stroke.
A refinement of CHAD2 is the CHA2DS2-VASc score- it incorporates additional stroke risk factors.
CHAD2DS2-VASc advantage is to identify truly low risk individuals that likely do not benefit from anticoagulation.
C Congestive heart failure -score 1
H Hypertension: -score 1
A2 Age ≥75 years -score 2
D Diabetes Mellitus -score 1
S2 Prior Stroke or TIA or thromboembolism-score 2
V Vascular disease -score 1
A Age 65-74 years -score 1
Sc Sex category (ie female gender) -score 1
The maximum CHADS2 score is 6, and the maximum CHA2DS2-VASc score is 9.
Stroke Risk % PER Year
0 1.9 1.2–3.0
1 2.8 2.0–3.8
2 4.0 3.1–5.1
3 5.9 4.6–7.3
4 8.5 6.3–11.1
5 12.5 8.2–17.5
6 18.2 10.5–27.4
The annual rate of thromboembolic events associated with CHA2DS2-VASc score = 0 is 0% compared with 1.4% with CHADS2 =0in the same patients.
In present guidelines anticoagulation should be considered for AF patients with 1 or greater stroke risk factors or a CHAD2DS2-VaAS1 or greater.
The European Society of Cardiology guidelines recommend that if the patient has a CHADS2 score of 2 and above, oral anticoagulation therapy should be prescribed.
Anticoagulation based on the CHADS2 scoreScore Risk Anticoagulation Therapy Considerations
0 Low Aspirin Aspirin daily
1 Moderate Aspirin or Warfarin Aspirin daily or raise INR to 2.0-3.0
2 or greater Moderate or High Warfarin Raise INR to 2.0-3.0
Anticoagulation based on the CHA2DS2-VASc scoreScore Risk Anticoagulation Therapy Considerations
0 Low No antithrombotic therapy
1 Moderate Oral anticoagulant
Warfarin therapy reduces the risk of embolic stroke vs. aspirin or placebo in patients with AF and two or more CHADS2 risk factors.
CHAD2DS2VASc score: recommendations for a man with a score of two or greater and women was the score of three or greater, treatment with an oral anticoagulant is recommended.
Use of an oral anticoagulants can we considered in a man with a score of one and women with a score of two, it may be omitted in men with a score of zero and women with a score of one.
The decision utilize warfarin in atrial fibrillation using the CHADS2 score should be driven more by the patient’s risk of stroke than by the risk of bleeding (Chen WT et al).
2 or greater Oral anticoagulant
CHADS2 also a good predictor ischemic stroke in patients without atrial fibrillation.
In patients with PAF CHADS2 scores provide a prediction accuracy 92% for ischemic stroke.
The incidence of atrial fibrillation increases with the increase in CHADS2 and CHA2DS2-VASc scores.
The 2 above scores have a high performance in predicting atrial fibrillation than in predicting stroke.
The need for anticoagulation is based on assessment using the CHADS2 score.