Assessing stroke risk – easier than saying “CHA2DS2-VA Score”!
General Practitioner Dr Vivienne Miller takes a look at what’s changed in the recently updated CHA2DS2-VASC Score for the determination of stroke risk factors from atrial fibrillation.
The CHA2DS2-VA Score was updated from the CHA2DS2-VASC Score last year to exclude female sex (represented by Sc) in the determination of stroke risk factors from atrial fibrillation. The two scores are identical, apart from the exclusion of female sex, which is no longer considered an outright risk factor in stroke from atrial fibrillation, but more of a ‘risk modifier’ of this complication.1
This means that females being assessed of stroke risk would have an extra point on their score because of their sex, and hence would be more likely to be recommended to have anticoagulation when assessed at being at very low risk. Women with atrial fibrillation are overall at higher risk of stroke compared to men. This is particularly so when they scored 1 to 6 (but strangely, not 3) on the older CHA2DS2-VASC Score.1
Patients at increased thromboembolic risk who have atrial fibrillation (CHA2DS2-VA scores of two or more, and in some cases, scores of one) should be fully anticoagulated unless this is contraindicated. Aspirin is inappropriate and should not be used for this indication, but is still very much used in low dose for the secondary prevention of cardiovascular events.
Modern treatment would ...