CHA₂DS₂-VASc
Stroke Risk in Non-Valvular Atrial Fibrillation
Score the bleed-stroke tradeoff. Males ≥2 or females ≥3 → anticoagulate.
The board-friendly take on atrial fibrillation is that anticoagulation hinges on CHA2DS2-VASc, not on whether the rhythm is paroxysmal or persistent. CHF (1), Hypertension (1), Age 75+ (2), Diabetes (1), Stroke/TIA (2), Vascular disease (1), Age 65-74 (1), Sex female (1). Males scoring 2 or higher and females scoring 3 or higher meet criteria for oral anticoagulation; the female point only counts when at least one other risk factor is present. Pair the score with HAS-BLED to assess bleed risk, but high HAS-BLED is not a reason to skip anticoagulation — it's a reason to fix modifiable risks. AANP boards tests the threshold and the female-point caveat.
- CCHFHeart failure or LV systolic dysfunction — 1 point.
- HHypertensionHistory of HTN — 1 point.
- A₂Age ≥75Worth 2 points (the subscript matters).
- DDiabetes1 point.
- S₂Stroke / TIA / thromboembolismAny history — 2 points.
- VVascular diseasePrior MI, PAD, or aortic plaque — 1 point.
- AAge 65-741 point (does not stack with the A₂ above).
- ScSex category (female)1 point, but only counts if at least one other risk factor is present.
Clinical Context
Guides anticoagulation decisions in non-valvular A-fib. DOACs (apixaban, rivaroxaban) are preferred over warfarin unless the patient has mechanical valves or moderate-severe mitral stenosis.
Pair this with HAS-BLED when deciding whether to anticoagulate — a high bleed score doesn''t contraindicate anticoagulation, it flags modifiable factors to address first (uncontrolled HTN, NSAID use, alcohol). The AANP frequently tests the "sex category only counts if another risk factor is present" nuance.
Related Mnemonics
- 5 T's — Cyanotic Congenital Heart Defects
- 6 P's — Acute Limb Ischemia
- HAS-BLED — Bleeding Risk on Anticoagulation
- MR. PASS MVP — Systolic Murmurs
- MS ARD — Diastolic Murmurs
Sources
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