Mount Carmel Health Partners Clinical Guidelines Atrial Fibrillation | Page 10

TABLE I: Chronic Anticoagulation
CHA 2 DS 2 VASc Scoring*
Factor
Congestive heart failure
Hypertension
Age ≥75 years
Age 65 to 74 years
Diabetes mellitus
Stroke/TIA/VTE
Sex = female
Vascular disease (MI, PAD,
o r aortic plaque)
Points
1
1
2
1
1
2
1
1
Examples of AF patients with a score ≥2 who will need chronic
anticoagulation:
• A woman with any of these: hypertension, CHF,
age 65, diabetes, or vascular disease
• A 65-year-old with any of these: CHF, diabetes, or
vascular disease
• Any patient 75 years old and older
Cigarette smoking Family history of premature CHD (1st degree relative <60
years or female 1st degree relative <70 years)
BP >140/90 or on antihypertensive medication Non-HDL cholesterol >160
Low HDL cholesterol (men <40, women <50)
Score = 0 No therapy
Score = 1 Decision determined by bleeding risk
• Aspirin alone (75 mg to 325 mg daily) OR
• Aspirin plus clopidogrel
Score ≥ 2
Chronic anticoagulation:
NOACs (novel oral anticoagulants: apixaban, dabigatran,
Rivaroxaban, edoxaban):
• Recommended for most AF patients, unless
contraindicated or warfarin is strongly preferred
• Contraindicated in valvular heart disease (mitral stenosis or
valve surgery) or renal impairment (eGFR <30)
• Recommended if TTR (time in therapeutic INR range)
is ≥65%
Warfarin
• Mandatory choice in patients with valvular heart disease
Relative contraindications to anticoagulation include history of
transfusion-dependent bleed (≥2 units) or intracranial bleed
* Treat as score of 1 if only risk factors are female and age.
CHA₂DS₂-Vasc Score and Stroke Rates
The CHA₂DS₂-Vasc score is effective in
predicting future stroke in patients who
do not receive anticoagulation, as shown
in this chart.
CHA₂DS₂-Vasc
Total Score Stroke Rate
(% per year)
0 0%
1 1.3%
2 2.2%
3 3.2%
4 4.0%
5 6.7%
6 9.8%
7 9.6%
8 6.7%
9 15.2%
AFib - 10