CHADS-VA Bleeding Risk Score

CHA₂DS₂-VA Risk Score

The CHA₂DS₂-VA score has superseded the CHA₂DS₂-VASc score. As of 2025, it is recommended to use the CHA₂DS₂-VA score for stroke risk assessment in atrial fibrillation patients. By excluding the sex parameter, the CHA₂DS₂-VA score addresses concerns about overestimating stroke risk in women based solely on gender. This aims to prevent unnecessary anticoagulation in low-risk female patients, thereby reducing the potential for bleeding complications.

The CHA₂DS₂-VA score is a clinical tool designed to assess stroke risk in patients with non-valvular atrial fibrillation (AF). It is a modification of the widely used CHA₂DS₂-VASc score, with the primary distinction being the exclusion of sex parameter (female sex) as a risk factor.

Rationale for the development of CHA₂DS₂-VA

The CHA₂DS₂-VASc score includes female sex as a risk factor. However, recent studies have questioned the significance of female sex as an independent risk factor for stroke in AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age rather than sex alone. Consequently, the CHA₂DS₂-VA score was developed to provide a more accurate risk assessment by omitting the sex category component.

Components of the CHA₂DS₂-VA Score

The acronym CHA₂DS₂-VA represents the following parameters:

  • Congestive Heart Failure (1 point)
  • Hypertension (1 point)
  • A₂ge ≥75 years (2 points)
  • Diabetes Mellitus (1 point)
  • S₂troke, Transient Ischemic Attack (TIA), or Thromboembolism history (2 points)
  • Vascular Disease (1 point)
  • Age 65-74 years (1 point)

The total score ranges from 0 to 9, with higher scores indicating an increased risk of stroke (Table 1).

Interpretation of the CHA₂DS₂-VA score

CHA₂DS₂-VA ScoreRisk CategoryAnnual Stroke Risk (%)
0Low0.2
1Low0.6
2Intermediate2.2
3Intermediate3.2
4High4.8
5High7.2
6High9.7
7High11.2
8High10.8
9High12.2

Table 1. Interpretation of CHADS-VA score

References

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137(2):263-272. doi:10.1378/chest.09-1584.

Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182,678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33(12):1500-1510. doi:10.1093/eurheartj/ehr488.

Champsi S, et al. CHA₂DS₂-VASc or a non-sex score (CHA₂DS₂-VA) for stroke risk prediction in atrial fibrillation: a cohort study. Eur Heart J. 2023;45(36):3718-3726. doi:10.1093/eurheartj/ehad456.

Stroke Risk Stratification: CHA₂DS₂-VA or CHA₂DS₂-VASc? Heart Lung Circ. 2018;27(12):1478-1480. doi:10.1016/j.hlc.2018.08.011.

CHA₂DS₂-VA Score Calculator. Available at: https://chadsva.org/.

Updated on 2025-01-18