The CHADS2 scoring system is a clinical prediction rule used to assess the risk of stroke in patients with non-rheumatic atrial fibrillation. It assigns points based on various risk factors, with a higher total score indicating greater risk of stroke. It is used to determine if anticoagulation therapy is required. The HAS-BLED scoring system evaluates bleeding risk for patients on oral anticoagulants for atrial fibrillation by assigning points for different risk factors, with a score of 3 or more indicating increased risk of major bleeding within one year.

1. CHADS2 Scoring System
http://crisbertcualteros.page.tl

2. CHADS2 score:
• clinical prediction rule for assessing the risk of
stroke in patients with non-rheumatic atrial
fibrillation
• used to determine if treatment is required
with anticoagulation therapy or antiplatelet
therapy or not
• High CHADS2 score: greater risk of stroke
• Low CHADS2 score: lower risk of stroke

3. Condition Points
C Congestive Heart Failure 1
H Hypertension 1
A AGE >75yo 1
D Diabetes Mellitus 1
S2 Prior Stroke or TIA 2

4. CHADS2
Score
Stroke Risk % 95% confidence interval
0 1.9 1.2-3.0
1 2.8 2.0-3.8
2 4.0 3.1-5.1
3 5.9 4.6-7.3
4 8.5 6.3-11.1
5 12.5 8.2-17.5
6 18.2 10.5-27.4
Annual Stroke Risk with Respect to CHADS 2 Score

5. Anticoagulation based on the CHADS2 score
Score Risk
Anticoagulation
Therapy
Considerations
0 Low Aspirin Aspirin daily
1 Moderate
Aspirin or
Warfarin
Aspirin daily or raise INR to 2.0-
3.0, depending on factors such as
patient preference
2 or
greater
Moderate
or High
Warfarin
Raise INR to 2.0-3.0, unless
contraindicated (e.g. clinically
significant GI bleeding, inability to
obtain regular INR screening)

6. http://crisbertcualteros.page.tl

7. CHA2DS2-VASc score
http://crisbertcualteros.page.tl

8. Feature Score
Congestive Heart Failure 1
Hypertension 1
Age >75 years 2
Age between 65 and 74 years 1
Stroke/TIA/TE 2
Vascular disease (previous MI, PAD or
aortic plaque)
1
Diabetes mellitus 1
Female 1

10. HAS-BLED score
http://crisbertcualteros.page.tl

11. • is a therapeutic bleeding risk stratification
score for those on oral anticoagulants in atrial
fibrillation

12. Letter Clinical Characteristic Points Awarded
H Hypertension 1
A
Abnormal renal and liver
function (1 point each)
1 or 2
S Stroke 1
B Bleeding 1
L Labile INRs 1
E Elderly 1
D Drugs or alcohol (1 point each) 1 or 2
Maximum possible score is 9

13. H Hypertension -( systolic blood pressure >160 mmHg) (Points: 1 )
A Abnormal renal function ( defined as the presence of chronic dialysis or renal
transplantation
or serum creatinine 200µmol/L (>~2.3 mg/dL)) (Points: 1 )
Abnormal liver function ( defined as chronic hepatic disease (eg. cirrhosis) or
biochemical
evidence of significant hepatic derangement (eg. bilirubin >2x upper limit of
normal, in association
with AST/ALT/ALP >3x upper limit normal) (Points: 1 )
S Stroke (Previous history of stroke) (Points: 1 )
B Bleeding (Major bleeding history (anemia or predisposition to bleeding)) (Points: 1 )
L Labile INRs (refers to unstable/high INRs or poor time in therapeutic
range(eg<60%))(Points: 1)
E Elderly (age >/= 65) (Points: 1 )
D Drug Therapy (concomitant therapy such as antiplatelet agents, NSAID's) (Points: 1 )
Alcohol intake (consuming 8 or more alcoholic drinks per week) (Points: 1)

14. Feature Score
Hypertension (Systolic >= 160mmHg) 1
Abnormal renal function 1
Abnormal liver function 1
Age >= 65 years 1
Stroke in past 1
Bleeding 1
Labile INRs 1
Taking other drugs as well 1
Alcohol intake at same time 1
HAS-BLED score

15. The risk of major bleeding within one year in atrial fibrillation patients enrolled in the Euro
Heart Survey.
HAS-BLED, acronym: Hypertension [uncontrolled, >160 mmHg systolic), Abnormal renal/liver
function, Stroke, Bleeding history or predisposition [anemia], Labile INR [i.e.
therapeutic time in range <60%], Elderly (>65) and Drugs/alcohol concomitantly [antiplatelet
agents, non-steroidal anti-inflammatory drugs] [Maximum score 9].
HAS-BLED score n Bleeds, n Bleeds/100 patients*
0 798 9 1.13
1 1286 13 1.02
2 744 14 1.88
3 187 7 3.74
4 46 4 8.70
5 8 1 12.50
Any score 3071 48 1.56

16. • score of 3 or more indicates increased one
year bleed risk on anticoagulation sufficient to
justify caution or more regular review
> risk is for intracranial bleed, bleed requiring
hospitalization or a hemoglobin drop > 2g/L or
that needs transfusion.