🫀 CHA₂DS₂-VASc (AF stroke risk)（non-valvular AF stroke / thromboembolism risk）
Bedside scoring tool — not a hospital AI agent
- Stratify non-valvular AF stroke / thromboembolism risk to support OAC discussion
- Pair with HAS-BLED and patient preference for net clinical benefit
- Apply to valvular AF (moderate–severe mitral stenosis / mechanical valve) pathways
- Replace shared decision-making, renal dosing, or bleed-risk review
FormulaCHF 1, hypertension 1, age ≥75 2, diabetes 1, prior stroke/TIA 2, vascular disease 1, age 65–74 1, female sex 1.
StratificationHigher scores map to higher annual stroke risk; most guidelines anticoagulate men ≥ 2 and women ≥ 3 — female sex alone (score 1) is usually not an anticoagulation trigger.
SourcesSources: Lip 2010 (doi 10.1378/chest.09-1584); ESC AF 2024 (doi 10.1093/eurheartj/ehae176); ACC/AHA/ACCP/HRS 2023 (doi 10.1161/CIR.0000000000001193); China AF guideline (commonly 2023)
UseGuide oral anticoagulation decisions in AF.
StrataHigher scores map to higher annual stroke risk; most guidelines anticoagulate men ≥ 2 and women ≥ 3 — female …
LimitsThe 2023 ACC/AHA guideline still uses CHA₂DS₂-VASc (men ≥2, women ≥3). · The 2024 ESC guideline uses CHA₂DS₂-VA (sex not counted; ≥2 recommend… · The 2023 China AF guideline uses CHA₂DS₂-VASc-60 (age 60–64 = 1, ≥65 …
SourceLip GYH, et al. Chest 2010
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Nonvalvular atrial fibrillation when deciding oral anticoagulation and the next step after bleeding.
- Who it is not for
- Valvular atrial fibrillation and mechanical valves do not use this card. Unrelated to PERC.
- Formula and variables
- Stroke risk uses CHA₂DS₂-VASc: heart failure, hypertension, age ≥75 (2), diabetes, prior stroke/TIA/embolism (2), vascular disease, age 65–74 and female sex, 1 point each. The 2024 ESC guideline uses CHA₂DS₂-VA without the sex item (≥2 recommend, 1 consider OAC); the 2023 ACC/AHA guideline still uses CHA₂DS₂-VASc (men ≥2, women ≥3). The 2023 China AF guideline uses CHA₂DS₂-VASc-60 (age 60–64 = 1, ≥65 = 2; OAC for men ≥2, women ≥3). This page scores the original CHA₂DS₂-VASc. Bleeding risk uses HAS-BLED.
- Result → next step
- Anticoagulation decisions open the atrial-fibrillation anticoagulation page: anticoagulate, hold for now, or individualize. A high bleeding score means fix reversible factors first; do not stop anticoagulation automatically. Bleeding opens the reversal page. No numeric reversal dose.AF anticoagulation →
- Guideline
- China atrial fibrillation guideline 2023
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Anticoagulate men ≥ 2 and women ≥ 3 in most guidelines.
When to use
Guide oral anticoagulation decisions in AF.
How it works
CHF 1, hypertension 1, age ≥75 2, diabetes 1, prior stroke/TIA 2, vascular disease 1, age 65–74 1, female sex 1.
Key points
- Anticoagulate men ≥ 2 and women ≥ 3 in most guidelines.
- Female sex is a risk modifier, not a standalone indication.
- Balance against bleeding risk (HAS-BLED).
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Congestive heart failure / LV dysfunction | No |
|---|---|
| Hypertension | No |
| Age | 65–74 (+1) |
| Diabetes | No |
| Prior stroke/TIA/thromboembolism | No |
| Vascular disease (MI/PAD/aortic plaque) | No |
| Sex | Male (0) |
→CHA₂DS₂-VASc1/9
- Recommendation：Consider oral anticoagulation (especially if not solely sex).
- Note：Female sex is a risk modifier, not a standalone indication; assess the non-sex score.
- China 2023：The 2023 China guideline uses CHA₂DS₂-VASc-60: age 60–64 scores 1 and 65–74 scores 2, one point more than this page (only in these two age bands); this page scores the original.
| Congestive heart failure / LV dysfunction | No |
|---|---|
| Hypertension | No |
| Age | ≥ 75 (+2) |
| Diabetes | No |
| Prior stroke/TIA/thromboembolism | No |
| Vascular disease (MI/PAD/aortic plaque) | No |
| Sex | Male (0) |
→CHA₂DS₂-VASc2/9
- Recommendation：Oral anticoagulation recommended.
- Note：Female sex is a risk modifier, not a standalone indication; assess the non-sex score.
- China 2023：The 2023 China guideline uses CHA₂DS₂-VASc-60: age 60–64 scores 1 and 65–74 scores 2, one point more than this page (only in these two age bands); this page scores the original.
Verification & sources · governance
FAQ
Frequently asked questions
- Should anticoagulation start at male 1 / female 2 points?
- Low scores are often a ‘consider’ band per applicable guidelines and local protocol; combine bleed risk and shared decision — not a hard cut from this score alone. Computed locally in the browser; patient data are not uploaded. For licensed clinicians only; combine with history, exam, and local protocol — not a standalone decision.
- Can valvular AF use this score to decide anticoagulation?
- No. Moderate–severe mitral stenosis or mechanical valves follow valvular AF pathways, not this score. Computed locally in the browser; patient data are not uploaded. For licensed clinicians only; combine with history, exam, and local protocol — not a standalone decision.
- Why pair with HAS-BLED?
- Stroke and bleed risks are weighed together; HAS-BLED highlights modifiable bleed factors — a high score is not itself an OAC contraindication. Computed locally in the browser; patient data are not uploaded. For licensed clinicians only; combine with history, exam, and local protocol — not a standalone decision.
- Are patient data uploaded, and where is it calculated?
- Computed locally in the browser; patient data are not uploaded. For licensed clinicians only; combine with history, exam, and local protocol — not a standalone decision.