Atrial Fibrillation Stroke Risk: CHA2DS2-VASc

Validated clinical prediction rule estimating 1-year ischemic thromboembolic stroke risk in patients with non-valvular atrial fibrillation.

Guides oral anticoagulation (DOACs/Warfarin) decision-making in non-valvular atrial fibrillation based on cumulative point scoring.

Systematic Breakdown

Signs/symptoms of HF or objective evidence of reduced LVEF (<= 40%).

Resting BP > 140/90 mmHg on at least two occasions or treated with antihypertensive medication.

Double-weighted risk factor; age is an exceptionally potent driver of thromboembolism.

Fasting glucose > 126 mg/dL (7.0 mmol/L) or treated with oral hypoglycemics/insulin.

Prior stroke, transient ischemic attack, or systemic embolus (double weighted).

Prior myocardial infarction, peripheral arterial disease, or complex aortic plaque.

Intermediate age bracket carries one point.

Female sex carries one point (only counts if patient has other risk factors).

High-Yield Clinical Pearls & Exam Tips

Score recommendations: Males >= 2 and Females >= 3 strongly indicate oral anticoagulation (DOAC preferred: Apixaban, Rivaroxaban).
Score 0 (males) or 1 (females with no other factors) = No anticoagulation or antiplatelet therapy recommended.
DOACs are contraindicated in mechanical heart valves and moderate-to-severe mitral stenosis (Warfarin required instead).

Related Pharmaceuticals

Apixaban Rivaroxaban Dabigatran Warfarin

Related Clinical Conditions

Atrial Fibrillation Ischemic Stroke Mitral Regurgitation

Authoritative Sources: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation · ESC Guidelines AFib 2020