CHA₂DS₂-VASc
Thromboembolic Risk Assessment in Atrial Fibrillation
Result
Interpretation
The CHA₂DS₂-VASc score estimates the annual risk of stroke in patients with non-valvular atrial fibrillation. The indication for anticoagulation is stratified by sex: in men, it is considered from a score of 1; in women, from a score of 2 — because a score of 1 obtained solely on the basis of female sex does not represent sufficient independent risk to warrant anticoagulation.
| Score | Annual stroke risk* | Recommendation (men) | Recommendation (women) |
|---|---|---|---|
| 0 | 0% | No indication for anticoagulation | — |
| 1 | 1.3% | Consider anticoagulation† | No indication (score 1 due to sex only) |
| 2 | 2.2% | Anticoagulation recommended | Consider anticoagulation† |
| 3 | 3.2% | Anticoagulation recommended | Anticoagulation recommended |
| 4 | 4.0% | Anticoagulation recommended | Anticoagulation recommended |
| 5 | 6.7% | Anticoagulation recommended | Anticoagulation recommended |
| 6 | 9.8% | Anticoagulation recommended | Anticoagulation recommended |
| 7 | 9.6% | Anticoagulation recommended | Anticoagulation recommended |
| 8 | 6.7% | Anticoagulation recommended | Anticoagulation recommended |
| 9 | 15.2% | Anticoagulation recommended | Anticoagulation recommended |
* Adjusted risk based on Lip et al., 2010 (Euro Heart Survey cohort). Absolute values vary between cohorts and populations.
† Individualized decision based on bleeding risk (HAS-BLED) and patient preference. ACC/AHA/ACCP/HRS 2023 and ESC 2020 guidelines.
Clinical context: Anticoagulation should be individualized based on the risk–benefit balance, taking into account bleeding risk (assessed using the HAS-BLED score) and patient preference. Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists in non-valvular atrial fibrillation, unless there is a specific contraindication. The 2023 ACC/AHA/ACCP/HRS guidelines continue to recommend CHA₂DS₂-VASc for stroke risk stratification. Note: the 2024 ESC Guidelines introduced the CHA₂DS₂-VA score (without the female sex component), arguing that female sex is not a sufficiently robust independent risk factor. Both approaches coexist in current clinical practice.
Notice: Use of this calculator is free. However, clinical decisions based on the results must be considered and taken by the clinician responsible for the patient's care. Inappropriate decisions may pose serious risks to health.
References
- 1. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation." Chest. 2010;137(2):263–272. PubMed ↗
- 2. Joglar JA, Chung MK, Armbruster AL, et al. "2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation." J Am Coll Cardiol. 2024;83(1):109–279. PubMed ↗