From the Guidelines
Neither provoked nor unprovoked Deep Vein Thrombosis (DVT) contributes points toward the CHA2DS2-VASc score. The CHA2DS2-VASc score is designed to assess stroke risk in patients with atrial fibrillation and includes points for Congestive heart failure, Hypertension, Age (≥75 years counts as 2 points, 65-74 years as 1 point), Diabetes, prior Stroke/TIA/thromboembolism (2 points), Vascular disease, and Sex category (female) 1. Deep vein thrombosis, whether provoked or unprovoked, is not included in this scoring system. If you're assessing venous thromboembolism risk, different scoring systems such as the Wells score or IMPROVE VTE risk assessment would be more appropriate. These systems do consider previous DVT history as a risk factor, but they are distinct from the CHAD2VASC score used for atrial fibrillation patients. Some studies discuss the categorization of patients as having provoked or unprovoked venous thromboembolism, but this is not relevant to the CHA2DS2-VASc score 1. The most recent and highest quality study on the topic of anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 does not mention DVT as a component of the score 1.
Some key points to consider when assessing stroke risk in patients with atrial fibrillation include:
- The CHA2DS2-VASc score is a widely used and recommended tool for assessing stroke risk in patients with atrial fibrillation 1
- The score includes points for several clinical factors, but does not include DVT
- Different scoring systems, such as the Wells score or IMPROVE VTE risk assessment, are used to assess venous thromboembolism risk and do consider previous DVT history as a risk factor.
From the Research
Contribution to CHA2DS2-VASc Score
- The CHA2DS2-VASc score is used to estimate the risk of stroke in patients with atrial fibrillation, not directly related to Deep Vein Thrombosis (DVT) [ 2, 3, 4, 5, 6 ].
- However, studies have shown that patients with unprovoked VTE have a higher risk of arterial cardiovascular events than patients with provoked VTE [ 2, 3 ].
- The risk of recurrent VTE is higher in patients with unprovoked VTE than in those with provoked VTE [ 4, 5 ].
- The CHA2DS2-VASc score does not directly account for the distinction between provoked and unprovoked DVT [ 2, 3, 4, 5, 6 ].
Provoked and Unprovoked DVT
- Provoked DVT is associated with a higher risk of major arterial events, particularly in patients with cancer [ 3 ].
- Unprovoked DVT is associated with a higher risk of recurrent VTE [ 4, 5 ].
- The distinction between provoked and unprovoked DVT is important for determining the risk of recurrent VTE and the optimal duration of anticoagulation therapy [ 4, 5, 6 ].
Relevance to CHA2DS2-VASc Score
- There is no direct evidence that both provoked and unprovoked DVT contribute to the CHA2DS2-VASc score [ 2, 3, 4, 5, 6 ].
- The CHA2DS2-VASc score is primarily used to estimate the risk of stroke in patients with atrial fibrillation, and its application to DVT is not well established [ 2, 3, 4, 5, 6 ].