CHA2DS2VaSc

Question 1

What does CHA2DS2VaSc measure?

Answer 1

Stroke risk in AF

Question 2

What are the component of the score?

Answer 2

Congestive heart failure (PMH) = 1 point.

HTN (PMH) = 1 point.

Age (personal information) –
65 ≤ age < 75 = 1 point.
≥75 = 2 points.

Diabetes (PMH) = 1 point.

Stroke/TIA (PMH) = 2 points.

Vascular disease (PMH) = 1 point.

Sex category female (personal information) = 1 point.

Question 3

What is recommended if they score 0 / 1 (Female)

Answer 3

No anticoagulation required

Question 4

What is recommended if they score 1 (male)?

Answer 4

consider anticoagulation with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.

Question 5

What is recommended if they score 2 or greater?

Answer 5

anticoagulation required with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban).

Question 6

What is recommended if they are already on anticoagulation?

Answer 6

Manage modifiable risk factors for bleeding
- (HAS BLED –
uncontrolled HTN,
renal/liver disease, labile
INR, using NSAIDs
/antiplatelets, alcohol
consumption).
For those on warfarin - assess anticoagulation control
For those on apixaban, dabigatran, rivaroxaban - monitor the drug

Question 7

What general lifestyle advice can you give?

Answer 7

Avoid alcohol.
Smoking cessation.
Healthy diet.
Exercise.

Question 8

What warfarin advice can you give?

Answer 8

Needs INR check.
Teratogenic.
Can interfere with other medications.
Increased bleeding risk.
Diet control.
Can be reversed with vitamin K.

Question 9

What NOACs advice can you give?

Answer 9

Non-reversible
Increased bleeding risk, Expensive,
CI with renal impairement and hx of GI bleed