There was a dramatic increase in the use of oral anticoagulation several years ago when use of the CHA2DS2 stroke risk prediction rule became commonplace in clinical practice. It was revised a few years later to improve risk prediction with the addition of the “Vasc” (for vascular disease, eg, PAD, MI, plaque) component. Now, it is the number one guideline-endorsed way to predict thromboembolic risk in atrial fibrillation and determine whether oral anticoagulants should be used. Yet, it has some limitation and continues to draw criticism.
For example, there is evidence that it underestimates risk when applied to the Danish National Patient Registry and is inaccurate at scores above 6 (decreasing stroke rate). Furthermore, it does not change with interventions that alter stroke risk (eg, anticoagulation). In addition, with a CHA2DS2-Vasc score of 0, predicted stroke risk is nearly 0%, which is known to be inaccurate. And finally, a table (or memorization) is required to correlate the score with the predicted stroke risk. See Figure 1 above (please click image to enlarge).
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