CHADS2 scoring debate continues

CHA2DS2-VASc is an alternative, newer risk stratification model proposed because many other risk factors for thromboembolism are not included in CHADS2. It adds presence of vascular disease, female sex, and age 65 to 74 years, as well as an increased allotment (from 1 point in CHADS2) to 2 points for age 75 years or older. Other risk assessment models, it is argued, not only omit these risk factors but also have low predictive ability and result in too many patients being categorized as intermediate risk. The latter consequence causes concern that treatment decisions about anticoagulant or antiplatelet therapy are then made by clinicians who may lack experience to determine the best course of action.

CHA2DS2-VASc suitably identifies patients at low risk; however, it classifies more patients as high risk, resulting in their receiving anticoagulation therapy, which may place them at risk for bleeding. No head-to-head comparison of the 2 methods has been made to determine the difference in risk. The authors of this review comment that until there is more evidence, it is reasonable to continue using CHADS2 because of its simplicity and the lack of data regarding bleeding risk between these methods.