The COR and LOE of warfarin, dabigatran, rivaroxaban, and apixaban are unchanged from the 2014 AF Guideline. comparing NOACs with warfarin. There was consistent evi- dence of at least noninferiority for the combined endpoint of stroke or systemic embolism. When combined with a superior safety profile, they are recommended as firstline therapy for eligible patients. 4. The recommendation is similar to the 2014 AF Guideline. New evidence has appeared that emphasizes the substantial variation across dif- ferent cohorts of patients with AF, including various non-European populations, in overall stroke rates for a given CHA2 -VASc point Additional approaches to stroke risk prediction and serious net clinical outcome pre- diction in selected patients with AF, including for specific anticoagulant management, have been Anticoagulation for AF and hypertrophic cardiomyopathy remain the same as in the 2014 AF Guideline. Patients with bioprosthetic heart valves were not included in studies validating the CHA2 - VASc scoring system. For bioprosthetic valves, very limited published experience exists for the use of the CHA2 -VASc scoring system for long-term assessment of thromboembolism risk in patients with AF. In 1 brief report in patients with AF, increasing age and the CHA2 -VASc score were independent predictors of thrombo- embolic events. In these patients with AF, a low -VASc score was associated with low thromboembolic risk regardless of whether the patients had bioprosthetic valves.S4.1.1-43 In addi- tion, in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; apixaban) and ENGAGE AF- TIMI 48 (edoxaban) AF trials, small numbers of these patients (with mitral or aortic bioprosthet- ic valve implants) were included. 