Age >75 years, for example, is a factor favoring rather than opposing anticoagulation.377 One bleeding risk that appears sufficient to tip the balance away from anticoagula- tion in nonvalvular AF is a history of lobar ICH suggestive of cerebral amyloid angiopathy.419 Other risks for ICH such as certain genetic profiles or the presence of asymptomatic cerebral microbleeds on neuroimaging do not currently appear sufficient by themselves to outweigh the benefits of antico- agulation in patients at average risk of cardioembolism.420 For patients treated with adjusted-dose warfarin, the initial 3-month period is a particularly high-risk period for bleeding421 and requires especially close anticoagulation monitoring. ICH is the most devastating complication of anticoagulation, but the absolute increase in risk is small for INR 3.5.387 Treatment of hypertension in AF patients reduces the risk of both ICH and ischemic stroke and hence has dual benefits for antico- agulated patients with AF.422 424 A consensus statement on the delivery of optimal anticoagulant care (focusing primarily on warfarin) has been published.425 The combined use of warfa- rin with antiplatelet therapy increases the risk of intracranial and extracranial hemorrhage.426 Because adjusted-dose warfa- rin (target INR, 2 to 3) appears to offer protection against MI comparable to that provided by aspirin in AF patients,427 the addition of aspirin is not recommended for most patients with AF and stable coronary artery disease.428,429 There are meager data on the type and duration of optimal antiplatelet therapy when combined with warfarin in AF patients with recent coronary angioplasty and stenting.430,431 The combination of clopidogrel, aspirin, and warfarin has been suggested for at least 1 month after placement of bare metal coronary stents in patients with AF.432 Because drug-eluting stents require even more prolonged antiplatelet therapy, bare metal stents are gen- erally preferred for AF patients taking warfarin.433,434 A lower target INR of 2.0 to 2.5 has been recommended in patients requiring warfarin, aspirin, and clopidogrel after percutane- ous coronary intervention during the period of combined anti- platelet and anticoagulant therapy.435 Closure of the LAA has been evaluated as an alternative approach to stroke prevention in nonvalvular AF.436 In a trial of 707 subjects randomized 2:1 to percutaneous LAA closure with the WATCHMAN device (in which patients were treated with warfarin for at least 45 days after device placement, then aspirin plus clopidogrel from echocardiographically demon- strated closure of the LAA until 6 months after placement, then aspirin alone) versus adjusted-dose warfarin (target INR, 2 to 3), LAA closure was noninferior to warfarin for preventing the primary outcome of ischemic or hemorrhagic stroke, cardiac or unexplained death, or systemic embolism during the mean 18-month follow-up (RR, 0.62; 95% CI, 0.35 1.25; P<0.001 for noninferiority). 