Performance in usual clinical care may deteriorate because of less-restricted patient selec- tion and suboptimal adherence to the unmonitored drug. For patients who do experience bleeding com- plications, clinicians need to be aware that there is no antidote to reverse the anticoagulant effects of dabigatran.90 Given these concerns, it would be rea- sonable for VKA-experienced patients who are well controlled (ie, INR within therapeutic range a high proportion of the time) to continue on VKA therapy if they are satis ed with it and are tolerating it well rather than switching to dabigatran. There is evidence from meta-analyses of RCTs92 that home monitoring of VKA therapy reduces throm- boembolic events by 42% compared with usual monitoring (see also Holbrook et al91), which is about major bleeding), we suggest combination therapy with aspirin and clopidogrel rather than aspirin (75 mg to 325 mg once daily) (Grade 2B). Remarks: Patients who place an exceptionally high value on stroke reduction and a low value on avoiding bleeding and the burden associated with anticoag- ulant therapy are likely to choose oral anticoagula- tion rather than antiplatelet therapy. Other factors that may in uence the choice among antithrombotic therapies are a consideration of bleeding risk and the presence of additional risk factors for stroke, including age 65 to 74 years and female gender, which have been more consistently validated, and vascular disease, which has been less well validated (see sec- tion 2.1.12). The presence of multiple non-CHADS2 risk factors for stroke may favor oral anticoagulation therapy. 