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Calculateur de score CHA2DS2-VASc
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Interprétation du score CHADS-VASc et décisions sur l’anticoagulation
| Men | Women | |||
|---|---|---|---|---|
| Points | Recommendation | Evidence | Recommendation | Evidence |
| 0 | No treatment | Low | No treatment | High |
| 1 | Oral anticoagulation (warfarin or NOAC1) is considered for male patients with a score of 1 or more. Patient preference and risk-benefit balance determine whether treatment is initiated. | High | No treatment | High |
| 2 | Oral anticoagulation (warfarin or NOAC) is recommended for all male patients with scores of 2 or more. | Very high | Oral anticoagulation (warfarin or NOAC) is considered for female patients with scores of 2 or more. Patient preference and the balance of risk and benefit determine whether treatment is initiated. | High |
| 3-9 | As above. | Very high | Oral anticoagulation (warfarin or NOAC) is recommended for all female patients with a score of 3 or more. | Very high |
If oral anticoagulation is indicated, NOACs should be chosen except in patients with moderate to severe mitral stenosis or mechanical heart valves; for these patients, warfarin is chosen instead (Class 1 B recommendation).
There are several models for risk-stratifying patients with atrial fibrillation, and CHADS-VASc is currently the most widely used model. The aim of CHADS-VASc is to identify patients at high risk of stroke, TIA or systemic thromboembolism and initiate treatment with anticoagulants (rarely with antiplatelet agents). CHADS-VASc predicts the risk of thromboembolism (stroke, TIA, systemic thromboembolism) in the next 12 months and the calculations apply to untreated patients with non-valvular atrial fibrillation (Table 1).
| CHADS-VASc Score | Risk of ischemic stroke | Risk för stroke/TIA/systemisk tromboembolism |
| 0 | 0.2% | 0.3% |
| 1 | 0.6% | 0.9% |
| 2 | 2.2% | 2.9% |
| 3 | 3.2% | 4.6% |
| 4 | 4.8% | 6.7% |
| 5 | 7.2% | 10.0% |
| 6 | 9.7% | 13.6% |
| 7 | 11.2% | 15.7% |
| 8 | 10.8% | 15.2% |
| 9 | 12.2% | 17.4% |
CHADS-VASc score
- C : Congestive heart failure (1 point)
- H : Hypertension (1 point)
- A : Age 75 and older (2 points)
- D : Diabetes mellitus (1 point)
- S : Prior stroke or TIA or thromboembolism (2 points)
- V : Vascular disease (1 point)
- A : Age 65 to 74 years (1 point)
- Sc : Sex category: being female (1 point)
In clinical trials (see References), patients with non-valvular atrial fibrillation and a CHADS-VASc score of 0 have had a very low incidence of thromboembolic events; therefore, withholding treatment should be considered. Among patients who are updated for anticoagulation, bleeding risk should be calculated using risk models such as ATRIA or HAS-BLED. There is at best weak support that acetylsalicylic acid (ASA) can be used as monotherapy (this means that acetylsalicylic acid should not, as a rule, be used for stroke prevention in patients with atrial fibrillation).