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. 2012 Aug;58(8):850–858.

Table 1.

The CHADS2 score for estimating risk of stroke in patients with AF: Points are allocated by the CHADS2 risk criteria (congestive heart failure [symptoms in past 3 mo], 1 point; hypertension [diagnosis], 1 point; age ≥ 75 y, 1 point; diabetes mellitus, 1 point; stroke or TIA [prior], 2 points).

CHADS2 SCORE ADJUSTED STROKE RATE, %/Y (95% CI) RECOMMENDED THERAPY* (STRENGTH OF RECOMMENDATION)
2012 CCS GUIDELINES3† 2010 ESC4 AND 2012 ESC TASK FORCE‡ 2012 ACCP GUIDELINES55†
0 1.9 (1.2–3.0)

  • No additional factors for risk of stroke: no antithrombotic treatment

  • Female sex or vascular disease: ASA 75–325 mg/d by mouth

  • Age ≥ 65 y or female sex and vascular disease: oral anticoagulant (grade 2C)

 Calculate CHA2DS2-VASc score (level 1A)

  • No antithrombotic (grade 2B)

  • If patient prefers therapy, ASA 75–325 mg/d (grade 2B)
1 2.8 (2.0–3.8) Preferred:

  • Oral anticoagulant (grade 1A)


Alternative:

  • ASA 75–325 mg/d (grade 2B)

 Calculate CHA2DS2-VASc score (level 1A) Preferred:

  • Oral anticoagulant (grade 1B)


Alternatives:

  • ASA with clopidogrel (grade 2B)

  • ASA 75–325 mg/d (grade 2B)
2 4 (3.1–5.1) Oral anticoagulant (grade 1A) Oral anticoagulant (level 1A) Preferred:

  • Oral anticoagulant (grade 1A)


Alternatives:

  • ASA with clopidogrel (grade 1B)

  • ASA 75–325 mg/d (grade 1B)
3 5.9 (4.6–7.3)
4 8.5 (6.3–11.1)
5 12.5 (8.2–17.5)
6 18.2 (10.5–27.4)

ACCP—American College of Chest Physicians, AF—atrial fibrillation, ASA—acetylsalicylic acid, CCS—Canadian Cardiovascular Society, CHA2DS2-VASc—congestive heart failure; hypertension; age ≥ 75 y; diabetes mellitus; stroke or TIA (prior); vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque); age 65–74 y; sex category (ie, female), ESC—European Society of Cardiology, TIA—transient ischemic attack.

*

The guidelines are fairly consistent in recommendations for patients with a CHADS2 score of ≥ 2. Varying recommendations for those with lower CHADS2 scores reflect the need for clinical judgment in areas of uncertainty.

†

Grade 1A is a strong recommendation based on high-quality evidence; grade 1B is a strong recommendation based on moderate-quality evidence; grade 2A is a weak or conditional recommendation based on high-quality evidence; grade 2B is a weak or conditional recommendation based on moderate-quality evidence; and grade 2C is a weak or conditional recommendation based on low- or very low-quality evidence.

‡

Level I evidence is evidence or general agreement that a given treatment or procedure is beneficial, useful, or effective. Level A evidence includes data derived from multiple randomized clinical trials or meta-analyses.