From the Guidelines
New thrombocytopenia is not a component of the CHA₂DS₂-VASc score, which is used to assess stroke risk in patients with atrial fibrillation. The CHA₂DS₂-VASc score includes points for congestive heart failure (1 point), hypertension (1 point), age ≥75 years (2 points), diabetes mellitus (1 point), prior stroke/TIA/thromboembolism (2 points), vascular disease (1 point), age 65-74 years (1 point), and female sex category (1 point) as outlined in the 2016 ESC guidelines for the management of atrial fibrillation 1. Thrombocytopenia (low platelet count) is not part of this scoring system but should be considered separately when evaluating bleeding risk in patients who might need anticoagulation based on their CHA₂DS₂-VASc score.
- Key components of the CHA₂DS₂-VASc score include:
- Congestive heart failure or signs/symptoms of heart failure
- Hypertension
- Age ≥75 years
- Diabetes mellitus
- Previous stroke, transient ischaemic attack, or thromboembolism
- Vascular disease
- Age 65–74 years
- Sex category (female) If a patient develops thrombocytopenia while on anticoagulation, this represents an increased bleeding risk that should prompt reassessment of the anticoagulation strategy, possibly including dose adjustment, temporary discontinuation, or alternative anticoagulation approaches depending on the severity of thrombocytopenia and the patient's stroke risk, as suggested by the guidelines 1.
From the Research
Scoring New Thrombocytopenia with CHADVASc Score
- The CHA2DS2-VASc score is a clinical prediction rule for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation, but it has also been used to predict thromboembolic events and mortality in other patient populations 2, 3, 4, 5, 6.
- The score is calculated based on the following components:
- Congestive heart failure (1 point)
- Hypertension (1 point)
- Age ≥ 75 years (2 points)
- Diabetes mellitus (1 point)
- Prior stroke or transient ischemic attack (2 points)
- Vascular disease (1 point)
- Age 65-74 years (1 point)
- Female sex category (1 point)
- The total score ranges from 0 to 9, with higher scores indicating a higher risk of stroke and thromboembolic events 2, 3, 5.
- Studies have shown that the CHA2DS2-VASc score is a useful predictor of thromboembolic events and mortality in patients with and without atrial fibrillation 2, 3, 6.
- The score has been validated in various patient populations, including Asian patients with atrial fibrillation 5 and patients without atrial fibrillation who have implantable cardiac monitoring devices 6.
Application of CHA2DS2-VASc Score in Thrombocytopenia
- There is limited evidence on the use of the CHA2DS2-VASc score in patients with thrombocytopenia.
- However, the score may be useful in predicting thromboembolic events and mortality in patients with thrombocytopenia, particularly those with underlying cardiovascular disease or other risk factors 2, 3, 6.
- Further studies are needed to validate the use of the CHA2DS2-VASc score in patients with thrombocytopenia and to determine its clinical utility in this patient population.