Question 1

Do I still need to calculate CHA₂DS₂-VASc if the patient is already on anticoagulation?

Accepted Answer

Yes — the score describes the underlying thromboembolic risk, not the effect of treatment. A high score even on warfarin or a DOAC should prompt review of adherence, dose adequacy, and modifiable risk factors.

Question 2

Why does female sex carry a point?

Accepted Answer

Female sex is not an independent risk factor for stroke on its own, but it modifies risk once other factors are present. The 2020 ESC guidelines advise that female sex without other risk factors (CHA₂DS₂-VASc = 1) does not require anticoagulation.

Question 3

Should I use CHA₂DS₂-VASc for valvular AF?

Accepted Answer

The score was developed and validated in non-valvular AF. Patients with rheumatic mitral stenosis or mechanical heart valves have an independent indication for anticoagulation (usually warfarin) and do not need risk-score-based decision-making.

Question 4

How often should I re-score?

Accepted Answer

Re-calculate at least annually or whenever a new risk factor develops (e.g., new diagnosis of diabetes, heart failure, or vascular disease). Age is a dynamic variable and may cross the 65- or 75-year threshold.