**5. Anticoagulation therapy in atrial fibrillation**

As stipulated previously, no stroke risk prediction scores have been specifically developed for patients with CKD and AF. It has been shown, however, that patients with CKD and nonvalvular AF have a heightened stroke risk regardless of CHADS2DS2-VASc score, where 80% of patients having scores of ≥2 [29]. Current ACC/AHA/ESC guidelines advise that for a CHADS2 score of ≥2 for either men or women, formal anticoagulation is recommended for patients [3, 9, 15, 16, 20, 22–26, 30]. Those with a CHADS2 score of 1, formal anticoagulation or aspirin alone should be considered in conjunction with patient specific comorbidities [3, 9, 15, 16, 20, 22–26]. Finally, the guidelines state for patients with a CHADS2 score of 0, no anticoagulation, neither formal nor antiplatelets, is recommended [3, 9, 15, 16, 20, 22–26]. In comparison with the American guidelines, the European guidelines recommend that males with a CHA2 DS2 -VASc score of ≥2 then anticoagulation should be used for stroke prevention, whereas those with a score of 1 should only be considered for anticoagulation, depending also on patient comorbidities and other risk factors [15, 20, 22–24]. Furthermore, for females, as female gender has been shown to be a weak risk factor for stroke in AF, guidelines advise that a CHA2 DS2 -VASc score of ≥3, then anticoagulation is recommended; however if the score is 2, then anticoagulation be considered [15, 20, 22–24]. If the CHA2DS2-VASc score is 0 in men and women or is 1 in women, neither formal anticoagulation nor antiplatelet therapy is advised or required [15, 20, 22–24].
