CHA₂DS₂-VASc Stroke Risk
Select patient sex and risk factors to calculate CHA₂DS₂-VASc score. Use the result to guide decisions on oral anticoagulation in non-valvular atrial fibrillation.
CHA₂DS₂-VASc score
0
Includes sex category (Sc) if female.
Annual stroke risk
<1%
Estimated risk without anticoagulation.
How to Use This Calculator
Select patient sex
Female sex contributes 1 point to the score and increases thromboembolic risk.
Toggle applicable risk factors
Each item corresponds to established CHA₂DS₂-VASc criteria. Age components are mutually exclusive (65–74 vs ≥75 years).
Review score and recommendations
Discuss anticoagulation, bleeding risk (HAS-BLED), and patient preferences in shared decision-making.
Formula
CHA₂DS₂-VASc =
- Congestive heart failure / LV dysfunction = 1
- Hypertension = 1
- Age ≥75 years = 2
- Diabetes mellitus = 1
- Stroke/TIA/thromboembolism = 2
- Vascular disease (MI, PAD, aortic plaque) = 1
- Age 65–74 years = 1
- Sex category (female) = 1
Full Description
The CHA₂DS₂-VASc score stratifies stroke risk in non-valvular atrial fibrillation and guides anticoagulation decisions. Compared with CHADS₂, it improves sensitivity by including vascular disease, age 65–74, and female sex. Scores ≥2 in men or ≥3 in women generally warrant oral anticoagulants (DOACs preferred). Assess bleeding risk (HAS-BLED), renal function, and patient preferences during shared decision-making.
Annual stroke percentages derive from cohort studies and provide context for risk communication. Close follow-up is necessary to monitor for bleeding, adherence, renal dose adjustments, and changes in risk factors.
Frequently Asked Questions
How often should CHA₂DS₂-VASc be reassessed?
Recalculate annually or when new risk factors develop (e.g., age thresholds, stroke, vascular disease).
What about patients with valvular AF?
CHA₂DS₂-VASc applies to non-valvular AF. For rheumatic mitral stenosis or mechanical valves, anticoagulate regardless of score (warfarin).
Do anticoagulants eliminate stroke risk?
No therapy completely eliminates risk. DOACs and warfarin reduce risk by ~60–70%. Continue lifestyle modifications (blood pressure control, sleep apnea treatment).
How does bleeding risk influence decisions?
Use HAS-BLED or ATRIA scores to estimate bleeding risk. High bleeding risk is not an absolute contraindication but signals need for closer surveillance and addressing modifiable factors (e.g., uncontrolled hypertension, labile INR).