03 / Stroke Risk

CHA₂DS₂-VASc

Stroke Risk in Nonvalvular Atrial Fibrillation

Lip GY, et al. Chest 2010;137(2):263–272 · 2024 ESC AF Guidelines

Score 0 / 9

CCongestive heart failure / LV dysfunction+1

Symptomatic heart failure or LVEF ≤ 40% (HFrEF or HFmrEF).

HHypertension+1

Resting BP > 140/90 mmHg on at least two occasions, or on antihypertensive therapy.

AAge

< 650 pts

65–74+1 pt

≥ 75+2 pts

DDiabetes mellitus+1

Fasting glucose > 125 mg/dL or on oral hypoglycemics/insulin.

S₂Stroke / TIA / thromboembolism+2

Prior ischemic stroke, transient ischemic attack, or systemic embolism.

VVascular disease+1

Prior myocardial infarction, peripheral artery disease, or aortic plaque.

ScSex category (female)+1

Female sex. Female sex alone does not warrant anticoagulation without another risk factor present.

Low risk

0 / 9 points

Clinical Interpretation · 2024 ESC AF Guideline

Annual Stroke Risk

2024 ESC AF guideline recommendation — anticoagulation is indicated (Class I) at ≥2 in men and ≥3 in women.
At 1 point in men or 2 in women, anticoagulation may be considered (Class IIa), based on individualized risk-benefit assessment.
In nonvalvular AF, DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) are preferred over warfarin.
Female sex alone does not warrant anticoagulation — the score is only clinically meaningful when another risk factor is present.
Assess bleeding risk alongside HAS-BLED, but use a high HAS-BLED score to address modifiable risk factors rather than to withhold anticoagulation.