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NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

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1. Prospective studies have shown that patients with an acute stroke and a significantly reduced eGFR have a higher mortality in comparison to those with moderate renal dysfunction. 
The R₂CHADS₂ score was based on a sub-analysis of the ROCKET AF study and the addition of 2 additional points in patients with moderate renal dysfunction, significantly improved its predictive value.  However, there are limitations to this study and subsequent analyses did not show any additive value when added to either the CHADS₂ or CH₂ADS₂-VASc scores.

2. All patients should undergo a bleeding risk evaluation before commencing anticoagulation.  A number of such algorithms exist for establishing this - click HERE to access these algorithms.

1. Gage BF, Waterman AD, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA : The Journal of the American Medical Association. 2001; 285: 2864-70.

2. Piccini JP, Stevens SR, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation. 2013; 127: 224-32.

3. Friberg L, Benson L, et al. Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the Swedish Atrial Fibrillation Cohort study. European heart journal. 2015; 36: 297-306.

4. Lip GY. Using the CHADS2 and CHA2DS2-VASc scores for stroke risk prediction as well as the identification of stroke outcomes and cardiac complications in patients with and without atrial fibrillation. Cerebrovasc Dis. 2013; 36: 281-2.

5. Consider a PUBMED search to explore other key references in this area.