CHAD Score

Aka: CHAD Score, CHADS Score, CHADS2

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II. Indication

  1. Assess Risk of stroke with Atrial Fibrillation

III. Contraindications: Conditions that if present may trump the decision to anticoagulate

  1. Valvular heart disease
  2. Prior peripheral embolism
  3. Intracardiac thrombus
  4. Hyperthyroidism

IV. Criteria: Mnemonic = CHADS

  1. Congestive Heart Failure (1 point)
    1. Relative Risk of Stroke or TIA: 1.4
  2. Hypertension (1 point)
    1. Relative Risk of Stroke or TIA: 1.6
  3. Age over 75 years (1 point)
    1. Relative Risk of Stroke or TIA: 1.4
  4. Diabetes Mellitus (1 point)
    1. Relative Risk of Stroke or TIA: 1.7
  5. Stroke or TIA history (2 points)
    1. Mitral Stenosis or Prosthetic Heart Valve carry similar risk and also indicate Warfarin
    2. Relative Risk of Stroke or TIA: 2.5

V. Disadvantages

  1. Does not account for atrial enlargement (higher risk of CVA)
  2. CHADS2-VASc Score is preferred over CHADS2 due to its greater efficacy

VI. Interpretation

  1. CHADS Score >2 (CVA risk >5% per year): Warfarin with goal INR 2.0 to 3.0
  2. CHADS Score 1 (CVA risk >4% per year): Warfarin or Aspirin
  3. CHADS Score 0: Aspirin 81 to 325 mg daily

VII. References

  1. Gage (2004) Circulation 110:2287-92 [PubMed]

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