The presence of multiple non-CHADS2 risk factors for stroke may favor oral anticoagulation therapy. 2.1.10 Recommendations for Patients With AF at High Risk of Stroke (eg, CHADS2 Score of 2, Which Includes Prior Ischemic Stroke or TIA): Patients at high risk of ischemic stroke, which includes patients with a history of ischemic stroke or TIA, can antici- pate large bene ts (ie, 15 fewer deaths and 30 fewer nonfatal strokes per 1,000 patients during 1 year of VKA therapy) with anticoagulation (Table 3). For every 1,000 patients with a CHADS2 score of 2 treated for 1 year with VKA therapy rather than aspirin, we anticipate 19 fewer nonfatal strokes at the expense of three more nonfatal major extracra- nial bleeds (Table 5). For every 1,000 such patients treated with VKA rather than combination therapy with aspirin and clopidogrel, we anticipate 11 fewer strokes and anywhere between four fewer to three more nonfatal major extracranial bleeds (Table 6). There is therefore a substantial net clinical bene t with oral anticoagulation. For patients at high risk of ischemic stroke with a CHADS2 score of 2 who are unsuitable for or who choose not to take an oral anticoagulant for reasons other than concerns about major bleeding (eg, dif - culty maintaining a stable INR, lifestyle limitations of regular INR monitoring, dietary restrictions that are too burdensome, or costs of new anticoagulant drugs that are too high), aspirin and clopidogrel therapy will result in a substantial reduction in stroke com- pared with aspirin alone (ACTIVE A trial) (Table 7). Patients opting for combination antiplatelet therapy rather than treatment with an oral anticoagulant should be informed that they are choosing an inferior treatment with regard to stroke prevention. Recommendation 2.1.10. 