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The CHA2DS2-VA score is a clinical prediction rule for estimating the risk of stroke in patients with non-valvular Atrial Fibrillation [AF]. It is used to guide whether a particular patient may benefit from anticoagulation. It is based on the CHA2DS2-VASc score but excludes gender as a risk factor.
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NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications.
This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.
All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.
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1. Prospective studies have shown that patients with an acute stroke and a significantly reduced eGFR have a higher mortality in comparison to those with moderate renal dysfunction.
The R2CHADS2 score was based on a sub-analysis of the ROCKET AF study and the addition of 2 additional points in patients with moderate renal dysfunction, significantly improved its predictive value. However, there are limitations to this study and subsequent analyses did not show any additive value when added to either the CHADS2 or CH2ADS2-VASc scores.
2. Patients should undergo a bleeding risk evaluation before commencing anticoagulation. A number of such algorithms exist for establishing this - click HERE to access these algorithms.
1. Lip GY, Nieuwlaat R, et al. 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: 263-72.
2.
Lip GY. Using the CHADS2 and CHA2DS2-VASc scores for stroke risk prediction as well as the identification of stroke outcomes and cardiac complications in patients with and without atrial fibrillation. Cerebrovasc Dis. 2013; 36: 281-2.
3. Maheshwari A, Norby FL, et al. Refining Prediction of Atrial Fibrillation-Related Stroke Using the P2-CHA2DS2-VASc Score. Circulation. 2019; 139: 180-91.
4. Hart RG, Pearce LA, et al. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Annals of Internal Medicine. 2007; 146: 857-67.
5. Olesen JB, Lip GY, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011; 342: d124.
6. Chao TF, Liu CJ, et al. Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians? Heart rhythm : the official journal of the Heart Rhythm Society. 2016; 13: 46-53.
7. Friberg L, Rosenqvist M, et al. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. European heart journal. 2012; 33: 1500-10.
8. Consider a PUBMED search to explore other key references in this area.
9. Click HERE to access the NICE guidelines on Atrial Fibrillation.
11. Click HERE to access the ESC guidelines for the management of Atrial Fibrillation..
12.
Champsi A, Mobley AR, Subramanian A, et al. Gender and contemporary risk of adverse events in atrial fibrillation. Eur Heart J. 2024;45(36):3707-17.
13.
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.
14. Yoshimura H, Providencia R, Finan C, et al. Refining the CHA2DS2VASc risk stratification scheme: shall we drop the sex category criterion? Europace. 2024;26(11).
15. Teppo K, Lip GYH, Airaksinen KEJ, et al. Comparing CHA(2)DS(2)-VA and CHA(2)DS(2)-VASc scores for stroke risk stratification in patients with atrial fibrillation: a temporal trends analysis from the retrospective Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) cohort. Lancet Reg Health Eur. 2024;43:100967.
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Updated:
01-Aug-2025