In CHADS2 Score and its renewed version of CHA2DS2-VASc, it is a prediction rule for estimating stroke risk in patients with a common heart arrhythmia associated with thromboembolic stroke, non-rheumatoid atrial fibrillation (AF). Such a score is used to determine whether anticoagulant or antiplatelet treatment is needed. Since AF can cause blood stasis to the upper chambers, which can cause mural thrombus that dislodges into the blood flow, reach the brain, stop brain supplies and cause a stroke. It also helps to determine whether treatment is necessary or not.
A high score is the same as a higher stroke risk, and a low score means the lower stroke risk. The result from CHADS2 is simple, validated by numerous studies. The CHADS2 score (pronounced "chads two") was replaced with the CHA2DS2-VASc score for clinical purposes, which shows better and satisfying results of patients with low-risk levels.
A score for CHA2DS2 VASc is the most frequently used way of predicting atrial fibrillation risk of thromboembolism. CHA2DS2 is commonly referred to as congestive heart failure, hypertension, age, diabetes, and previous stroke/transient ischemic attack and VASc stands for vascular disease (peripheral arterial disease, preceding myocardial infarction, aortic atheroma). This scoring system also includes the category of sex (women). Scientists developed ASCVD Risk Calculator to calculate heart failure risk. They researched on several factors like age, cholesterol level, smoking routine, and diabetes of individuals.
Each risk factor, as described above, is awarded 1 point except age > 75 and stroke/TIA 2 points. Patients 2 or more points of warfarin, dabigatran, rivaroxaban, or apixaban should receive full anticoagulation. Aspirin alone or full anticoagulation on the base of a specific individual can be treated for patients with one point. An annual risks stroke for a patient generally increases with the increase in CHA2DS2-VASc points. The following calculator describes points and risk equivalents.
|CHA2DS2VASc SCORE||ADJUSTED STROKE RATE (% year)|
|Score||CHA2DS2-VASc Risk Criteria|
|1 point||Congestive heart failure|
|2 point||Age >_75 years|
|1 point||Diabetes mellitus|
|2 point||Stroke/Transient Ischemic Attack/Thromboembolic event|
|1 point||Vascular disease (prior MI, PAD, or aortic plaque)|
|1 point||Age 65 to 74 years|
|1 point||Sex category (i.e. female sex)|
In the guidelines for the management of atrial fibrillation, the CHA2DS2-VASc score has been used in 2012 by the European Cardiology Society. The Task Force in 2014 on the Practice Guidelines and Guidelines of the Heart Rhythm Society recommend the use of the CHA2DS2-VASc score.
In the case of CHA2dS2-VASc, patients with oral anticoagulation (OAC) therapy with Vitamin K (VKA e.g. warfarin with target INR 2-3) or one non-VKA anticoagulant (NOACs, e.g. dabigatran, rivaroxaban, edoxaban, or apixaban) are recommended by the European Society of Cardiologie (ESC), and the National Institute of Care Excellence (NICE).
No anticoagulant treatment is recommended in patients who are' low risk' using the CHA2DS2-VASc score (i.e. 0 for the males or 1 for the females).
Antithrombotic therapy may be considered with OAC for males with a 1 Stroke Risk Factor (i.e., a CHA2DS2-VASc score=1), and people's values and preferences should be taken into consideration. Even a single stroke risk factor provides an overriding risk of stroke and mortality with a positive net clinical advantage when compared with no treatment or aspirin for stroke prevention with oral anticoagulation. As already mentioned, the rates of thromboembolic events vary according to different thresholds for treatment and methodological approaches.
|1||None of aspirin or OAC|
|2 or more||OAC|
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