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Score

CHA₂DS₂-VA

Thromboembolic risk in atrial fibrillation: 2024 version, without the sex criterion. Check the risk factors present.

Score0
CHA₂DS₂-VA 0
No anticoagulation

Score 0: anticoagulation not routinely recommended.

Check only the applicable age band (A₂ or A).
Decision rule

0 → no anticoagulation · 1 → consider (IIa) · ≥ 2 → anticoagulate.

A tool to support learning and decision-making. The result does not replace clinical evaluation of the patient.

About: CHA₂DS₂-VA

CHA₂DS₂-VA estimates thromboembolic risk in atrial fibrillation and guides the decision to start oral anticoagulation. It is the version adopted by the 2024 European guidelines, which removed the female sex criterion from the former CHA₂DS₂-VASc.

Each letter stands for a risk factor: heart failure, hypertension, age, diabetes, prior stroke or embolism, and vascular disease.

How to use

  1. Check the risk factors present.
  2. Choose only one age band: 65 to 74 years (1 point) or 75 years or older (2 points).
  3. Read the total score and the corresponding recommendation.

How to interpret

  • Score 0: anticoagulation not routinely recommended.
  • Score 1: consider anticoagulation (class IIa), individualizing the decision.
  • Score ≥ 2: oral anticoagulation recommended unless contraindicated.

Limitations

The score does not apply to atrial fibrillation with moderate to severe mitral stenosis or a mechanical heart valve. The decision should also consider bleeding risk and patient preference.

References

  1. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–414.