Which scoring system guides decisions regarding long-term anticoagulation in atrial fibrillation?

• A. CHA2DS2-VASc score
• B. HAS-BLED score
• C. APACHE II score
• D. Framingham risk score

Answer: (A)

Assessing stroke risk in atrial fibrillation guides whether to start and continue long-term anticoagulation. The CHA2DS2-VASc score is the standard tool for this purpose because it combines multiple risk factors into a single estimate of annual stroke risk and helps determine if the potential benefit of anticoagulation justifies treatment. It assigns points for congestive heart failure, hypertension, age 75 or older (2 points), diabetes, prior stroke/TIA/thromboembolism (2 points), vascular disease, age 65–74, and female sex. A higher total means a higher stroke risk and a greater likelihood that anticoagulation will be beneficial, whereas a score of zero often leads to withholding anticoagulation.

Other scoring systems serve different purposes: HAS-BLED estimates bleeding risk to help gauge safety and monitoring needs; APACHE II measures illness severity in critical care; Framingham risk estimates general cardiovascular risk rather than AF-specific stroke risk.