A 68-year-old man with non-valvular AF has a CHA₂DS₂-VASc score as follows: age 68 (1 point), hypertension (1 point), heart failure (1 point), diabetes (1 point). Total score = 4. His HAS-BLED score is 2. What is the annual stroke risk and should anticoagulation be initiated?
- A Annual stroke risk ~2%, anticoagulation recommended only if HAS-BLED <3
- B Annual stroke risk ~4%, anticoagulation recommended ✓
- C Annual stroke risk ~4%, anticoagulation contraindicated due to bleeding risk
- D Annual stroke risk <1%, aspirin is sufficient
Correct answer: B. Annual stroke risk ~4%, anticoagulation recommended
Explanation
A CHA₂DS₂-VASc score of 4 corresponds to an annual stroke risk of approximately 4%. Current ESC/ACC guidelines recommend anticoagulation for men with CHA₂DS₂-VASc ≥2 and women with ≥3. HAS-BLED score of 2 (low-to-intermediate risk) is not a contraindication to anticoagulation — it should prompt correction of modifiable bleeding risk factors (e.g., BP control), not withholding anticoagulation. DOACs are preferred over warfarin in non-valvular AF. Aspirin provides inadequate stroke protection in AF.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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