CHA2DS2-VA Score

What is CHA2DS2-VA?

CHA2DS2-VA is a clinical risk score used to estimate the risk of ischaemic stroke and systemic thromboembolism in patients with atrial fibrillation.

It is the sex-neutral version of CHA2DS2-VASc (female sex removed as a standalone point) and is used to support anticoagulation decisions in current ESC guidance.

How is the score calculated?

• Congestive heart failure / LV dysfunction: +1
• Hypertension: +1
• Age 65–74 years: +1
• Age ≥ 75 years: +2
• Diabetes mellitus: +1
• Prior stroke/TIA/systemic thromboembolism: +2
• Vascular disease: +1

Interpretation (ESC approach)

• Score 0: low risk.
• Score 1: elevated risk — anticoagulation should be considered.
• Score ≥2: elevated risk — anticoagulation is recommended.

How to use the result

This tool supports clinical judgment and should be used within local protocols. Always consider bleeding risk, comorbidities, patient preferences, and reassess thromboembolic risk periodically.

• Use in atrial fibrillation/flutter patients for stroke risk stratification (unless a different condition mandates anticoagulation).
• Score = 1 generally supports considering oral anticoagulation.
• Score ≥ 2 generally supports recommending oral anticoagulation unless contraindicated.
• Reassess risk over time (age and comorbidities can change).
• This score estimates thromboembolic risk; bleeding risk assessment is separate.