CHA2DS2?VASc stroke risk score

The CHA2DS2-VASc stroke risk score estimates the risk of stroke in people with non?valvular atrial fibrillation on a point scale of 1–9, using the following risk factors:

aged 65–74 years (1 point)

aged 75 years or older (2 points)

female (1 point)

congestive heart failure (1 point)

hypertension (1 point)

diabetes (1 point)

stroke, transient ischaemic attack or thromboembolism (2 points)

vascular disease – previous myocardial infarction, peripheral arterial disease, aortic plaque (1 point).

The UK guideline on atrial fibrillation recommends that bleeding risk, estimated using the HAS-BLED score, is taken into account when offering anticoagulation.
The HAS?BLED score estimates the risk of bleeding on a point scale of 1–9. Each of the following risk factors represents 1 point:

hypertension (uncontrolled; for example, systolic blood pressure higher than 160 mmHg)

renal disease (chronic dialysis, renal transplantation or serum creatinine of 200 micromol/litre or more)

liver disease (chronic hepatic disease such as cirrhosis or biochemical evidence of significant hepatic derangement [for example, bilirubin more than 2 times upper limit of normal in association with aspartate/alanine aminotransferase or alkaline phosphatase more than 3 times upper limit of normal])

stroke

major bleeding event or predisposition to bleeding

labile international normalised ratio (INR) for people taking vitamin K antagonists, unstable or high INRs or poor time in therapeutic range (for example, less than 60%)

age over 65 years

use of drugs such as antiplatelet agents or non?steroidal anti?inflammatory drugs

alcohol misuse or harmful excess.

G Mohan.