European guidance now scores thromboembolic risk in atrial fibrillation with CHA2DS2-VA rather than CHA2DS2-VASc: female sex is no longer one of the scoring criteria. It was removed because it behaves as a risk modifier rather than an independent risk factor, and because the old scheme produced a recurring clinical muddle in which a woman with no other risk factor scored one point and was discussed as though she needed anticoagulation.
The practical effect is that a woman and a man with the same clinical profile now get the same score and the same decision. If your clinic letters, referral templates or electronic record still calculate the older score, they are adding a point that current guidance does not, and someone downstream will act on it.
- Check whether your electronic record or clinic template still calculates CHA2DS2-VASc
- State which score you used in the letter, not just the number
- Do not anticoagulate a woman with no other risk factor on the basis of sex alone
- Remember that sex still affects stroke risk — it is no longer a scoring criterion, which is a different statement
- Recalculate rather than carry forward a score recorded years ago
Why it matters
A score copied forward from an older template quietly shifts the anticoagulation threshold for every woman in the clinic.
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