D. 4 – Explanation
One point for hypertension, one point for being over the age of 65 years (but under the age of 75
years) and two points (‘S2’) for the recent TIA.
Atrial fibrillation: anticoagulation
The European Society of Cardiology published updated guidelines on the management of atrial
fibrillation in 2012. They suggest using the CHA2DS2-VASc score to determine the most appropriate
anticoagulation strategy.
This scoring system superceded the CHADS2score.
The table below shows a suggested anticoagulation strategy* based on the score:
| Condition | Points | |
| C | Congestive heart failure | 1 |
| H | Hypertension (or treated hypertension) | 1 |
| A2 | Age >= 75 years | 2 |
| D | Diabetes | 1 |
| S2 | Prior Stroke or TIA | 2 |
| V | Vascular disease (including ischaemic heart disease and peripheral arterial disease) | 1 |
| A | Age 65-74 years | 1 |
| S | Sex (female) | 1 |
Score………… Anticoagulation
…0 ……………No treatment is preferred to aspirin
…1 ……………Oral anticoagulants preferred to aspirin; dabigatran is an alternative
…2 or more….. Oral anticoagulants; dabigatran is an alternative
*the wording in the guidelines (‘is preferred to’) can be slightly confusing. It basically means that, say
for a scoreof 0, whilst aspirin is an acceptable management option the weight of the clinical evidence
would support no treatment instead
