CHADS-65 (Canadian Society of Cardiology Guideline)
Guides antithrombotic therapy for patients with nonvalvular atrial fibrillation or atrial flutter.
This tool is based only on expert opinion from the Canadian Cardiovascular Society and is included in their 2020 guidelines for atrial fibrillation care.
Advice
- This score should be used in conjunction with clinical judgment, a thorough clinical evaluation, and specialist consultation (if needed).
- Consider evaluating the patient’s bleeding risk using a separate tool before prescribing anticoagulation (e.g., HAS-BLED, DOAC Score), and modify any bleeding risks, if possible.
- Discuss the risks and benefits of antiplatelet and anticoagulation therapy with the patient.
- Be sure to reassess a patient’s stroke risk periodically, particularly if their clinical status changes.
Management
- Oral anticoagulation therapy (a DOAC is preferred over warfarin for non-valvular atrial fibrillation) is recommended for stroke and systemic embolism prevention for patients with atrial fibrillation who are:
- 65 years or older.
- <65 years of age with a risk factor (i.e., CHADS₂ ≥1):
- Heart failure.
- Hypertension.
- Diabetes mellitus.
- Prior stroke or TIA.
- Antiplatelet therapy (e.g., ASA 81 mg daily) is recommended for patients <65 years of age and coronary artery disease or peripheral artery disease.
- For additional recommendations, see the CCS Atrial Fibrillation Guidelines.