were deemed unsuitable because of concern for warfarin- Dual antiplatelet therapy resulted in a significant reduction in all strokes (including parenchy- mal ICH) over treatment with aspirin alone (RR reduction, 28%; 95% CI, 17 38; P=0.0002) but also resulted in a sig- nificant increase in major bleeding (RR increase, 57%; 95% CI, 29 92; P<0.001). Overall and in absolute terms, major vascular events (the study primary end point) were decreased 0.8%/y, but major hemorrhages increased 0.7%/y (RR for major vascular events and major hemorrhages, 0.97; 95% CI, 0.89 1.06; P=0.54). Disabling/fatal stroke, however, was decreased by dual antiplatelet therapy (RR reduction, 26%; 95% CI, 11 38; P=0.001). A post hoc analysis of randomized trial data that used relative weighting of events suggested a modest net benefit from the combination of aspirin and clopi- dogrel over aspirin alone.416 Recommendations for the selection of antithrombotic therapy for patients with nonvalvular AF have had to adjust for 2 emerging trends: a decreasing rate of stroke for any possibly related to improv- ing control of other stroke risk factors, and the appearance of the newer oral anticoagulants with a lower risk of ICH. These 2 trends tend to have opposing effects on the tipping point at which the benefits of anticoagulation outweigh its risks: A lower stroke risk argues for more limited use of antico- agulation, and safer agents argue for more extensive use.418 On the basis of the decreasing risk of AF-related stroke, the 2012 American College of Chest Physicians evidence-based suggested that patients with nonrheu- matic AF at low stroke risk (ie, CHADS2 =0) be treated with no therapy rather than any antithrombotic agent (American College of Chest Physicians grade 2B; ie, weak recommenda- tion, moderate evidence); for those patients preferring anti- thrombotic treatment, aspirin rather than anticoagulation was recommended (grade 2B). 