Score Breakdown for This Patient
For an elderly male patient with hypertension, prior ischemic stroke, and atrial fibrillation, the CHA₂DS₂-VASc score is calculated as follows 1, 2:
- Hypertension (H): 1 point - History of hypertension or current antihypertensive treatment qualifies, regardless of current blood pressure control 2
- Age ≥75 years (A₂): 2 points - "Elderly" male patient indicates age ≥75 years, which receives doubled points as age is a major stroke risk factor 1, 2
- Prior Stroke (S₂): 2 points - History of ischemic stroke receives doubled points due to the highly elevated risk of recurrence 1, 2
- Sex category (Sc): 0 points - Male patients receive no points for sex 1, 2
Total Score: 1 + 2 + 2 + 0 = 5 points
However, if "elderly" is interpreted as age 65-74 years rather than ≥75 years, the calculation would be:
- Hypertension: 1 point
- Age 65-74 years: 1 point
- Prior stroke: 2 points
- Male sex: 0 points Alternative Total: 4 points 1, 2
Clinical Significance
A score of 4 points indicates high stroke risk with an annual stroke rate of approximately 4.0-8.2% 2. This substantially exceeds the 1% annual threshold that mandates oral anticoagulation therapy 3.
Treatment Implications
- Oral anticoagulation is strongly recommended (Class I indication) for any CHA₂DS₂-VASc score ≥2 2
- Direct oral anticoagulants (DOACs) are preferred over warfarin as first-line therapy 2
- The absolute benefit of anticoagulation substantially outweighs bleeding risk at this score level 2
- High bleeding risk should not be used as a reason to withhold anticoagulation 2
Important Clinical Caveat
The prior stroke alone (2 points) combined with any other risk factor automatically places this patient at high risk requiring anticoagulation, regardless of the exact numerical score 4. Patients with prior stroke or TIA warrant special attention and should receive anticoagulation regardless of their total CHA₂DS₂-VASc score 4.