When should anticoagulation be started based on CHA₂DS₂-VASc?

Current guidelines recommend: Score 0 (males) or 1 (females) = no anticoagulation needed. Score 1 (males) = consider anticoagulation. Score ≥ 2 = anticoagulation recommended. DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) are preferred over warfarin for most patients.

Does female sex alone warrant anticoagulation?

No. Female sex is a stroke risk modifier, not an independent risk factor. A CHA₂DS₂-VASc score of 1 from female sex alone does not warrant anticoagulation. The ESC guidelines effectively treat the female sex point as relevant only in the presence of at least one other risk factor.

How accurate is the CHA₂DS₂-VASc score?

CHA₂DS₂-VASc has moderate predictive accuracy (c-statistic ~0.6–0.7) but is better at identifying truly low-risk patients than the older CHADS₂ score. It is recommended by ACC/AHA, ESC, and CCS guidelines as the standard stroke risk assessment tool for atrial fibrillation.

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CHA₂DS₂-VASc Score

Estimate ischemic stroke risk in non-valvular atrial fibrillation/flutter to support anticoagulation decisions.

Eingaben

Geschlecht Sex category adds 1 point for female sex (risk modifier).

Alter (Jahre)

Congestive heart failure/LV dysfunction

Hypertension

Diabetes mellitus

Prior stroke/TIA/systemic embolism

Vascular disease (MI/PAD/aortic plaque)

—

Enter age and select risk factors.

Estimated annual stroke risk—

General anticoagulation guidance—

Haftungsausschluss: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteil. Guidance is simplified; follow local guidelines and individualize risk/benefit (bleeding risk, patient values, etc.).

Bewertung

CHF/LV dysfunction: +1
Hypertension: +1
Age ≥ 75: +2
Diabetes: +1
Stroke/TIA/systemic embolism: +2
Vascular disease: +1
Age 65–74: +1
Sex category (female): +1

Clinical pearls

Intended for non-valvular AF (not mechanical valves; moderate–severe mitral stenosis has different management).
Anticoagulation decisions should incorporate bleeding risk, contraindications, and shared decision-making.

References

Lip GYH, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in AF. Chest. 2010.
ESC Guidelines for AF (2020) and AHA/ACC/HRS AF guidelines (updates) for anticoagulation thresholds.

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Über dieses Tool

What Is the CHA₂DS₂-VASc Score?

The CHA₂DS₂-VASc score is a clinical prediction tool that estimates the annual risk of ischemic stroke in patients with non-valvular atrial fibrillation (AF). Developed by Lip et al. in 2010 as a refinement of the original CHADS₂ score, it incorporates additional risk factors — vascular disease, age 65–74, and female sex — to better stratify patients at the low-risk end of the spectrum. The score ranges from 0 to 9 and directly informs anticoagulation decision-making.

When to Use CHA₂DS₂-VASc

Calculate CHA₂DS₂-VASc in every patient with newly diagnosed or established non-valvular AF or atrial flutter to determine anticoagulation need. Current ESC (2020) and AHA/ACC/HRS guidelines recommend oral anticoagulation (OAC) for men with scores ≥2 and women with scores ≥3. A score of 1 (men) or 2 (women) represents an intermediate zone where anticoagulation should be "considered" based on individual risk-benefit assessment.

Interpreting CHA₂DS₂-VASc Results

A score of 0 (men) or 1 (women, where the sole point is female sex) identifies truly low-risk patients who may not benefit from anticoagulation. Higher scores correlate with progressively higher annual stroke rates — from approximately 1.3% at score 1 to over 15% at score 9. These estimates come from large registry data and vary somewhat across populations.

🔑 Klinische Hinweise

Female sex alone (score = 1 in women) is not an indication for anticoagulation — it is a risk modifier, not an independent driver.
Always pair CHA₂DS₂-VASc with a bleeding risk assessment (e.g., HAS-BLED) for shared decision-making. A high HAS-BLED does not contraindicate OAC — it identifies modifiable risk factors.
DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) are preferred over warfarin for most patients with non-valvular AF per current guidelines.
This score is NOT validated for valvular AF (mechanical heart valves, moderate-to-severe mitral stenosis) — those patients require warfarin.

Schlüsselreferenzen

Lip GYH, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in AF using a novel risk factor-based approach. Chest. 2010;137(2):263–272.
Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42(5):373–498.
January CT, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AF Guideline. J Am Coll Cardiol. 2019;74(1):104–132.

Formel zuletzt überprüft: Februar 2026