In recognition of the differential roles played by gender in the risk profiles and efficacy and safety results, the most important risk scoring system at present, CHADS₂ has been updated as the CHAD₂DS₂ vascular score (CHA₂DS₂-VASc), principally by the European community. [126] The updated CHA₂DS₂-VASc takes gender into account in calculating risk, whereas the CHADS₂ score does not (Figure).  

Moving forward, the fact that gender is a significant factor in CHA₂DS₂-VASc, especially in patients with a CHADS₂ score of 0 or 1, may give us the opportunity to be more accurate in risk stratifying patients, especially women.  One recommendation, as discussed by Dr Reiffel, would be to calculate the CHA₂DS₂-VASc score only in patients with a simpler CHADS₂ score of 0 or 1; at a CHADS₂ score of ≥2, the mandate to initiate antithrombin therapy is clear.

French WJ. Am J Med 2013; 126: 00-00.

[CHADS₂ = Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke (doubled); CHA₂DS₂-VASc = Congestive heart failure or left ventricular dysfunction, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female)]