CHA₂DS₂-VASc Score

Estimates stroke risk in patients with non-valvular atrial fibrillation (AF) to determine whether oral anticoagulation (e.g., DOACs, Warfarin) is indicated.

Congestive Heart Failure +1

History of CHF or LVEF ≤ 40%

Hypertension +1

BP > 140/90 mmHg or on HTN medication

Age

< 65 years 0 65 - 74 years +1 ≥ 75 years +2

Diabetes Mellitus +1

Treatment with oral hypoglycaemic/insulin or fasting glucose > 7 mmol/L

Stroke / TIA / Thromboembolism +2

Prior history

Vascular Disease +1

Prior MI, PAD, or aortic plaque

Sex Category (Female) +1

Female sex confers additional risk

Total Score

NICE Guidelines (NG196)

Score 0 (Men) or 1 (Women): Low risk. Anticoagulation is generally not recommended.
Score 1 (Men): Moderate risk. Consider anticoagulation.
Score ≥ 2: High risk. Offer anticoagulation. DOACs are generally first-line over Warfarin unless contraindicated.

Also consider calculating the HAS-BLED score to assess bleeding risk, though a high HAS-BLED score is not a contraindication to anticoagulation, but rather a prompt to address modifiable bleeding risks.

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