In the GEMINI-ACS-1 trial (A randomized trial to compare the safety of rivaroxaban vs aspirin in addition to either clopidogrel or ticagrelor in acute coronary 3,037 patients with ACS (ie, essentially a non-AF population) were randomly assigned to either aspirin 100 mg or rivaroxaban 2.5 mg bid, and the subsequent choice of clopidogrel (44%) or ticagrelor (in 56%) during trial conduct was nonrandomized. Low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of ACS patients had similar risks of clinically signi cant bleeding (5%) as aspirin and a P2Y12 inhibitor (HR, 1.09; 95% CI, 0.80-1.50; P .5840). Stable Vascular Disease: The presence of vascular disease adds to stroke risk in patients with AF. In the Danish registries, AF patients with vascular disease (prior MI, prior PAD, or aortic plaque) as a single risk factor have a high stroke rate of 4.85 per 100 person-years.291 This corresponds to CHA2DS2-VASc 1 for males and CHA2DS2-VASc 2 for females, with rates of 4.53 and 1170 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] 5.69, respectively. Contrasting low risk CHA2DS2-VASc (ie, score 0 [male] or 1 [female]) as a reference population vs those with $1 additional stroke risk factors (ie, CHA2DS2-VASc score 1 [males] or 2 [females]), the risk attributable to vascular disease had a crude HR of 2.7 PAD may confer an ischemic stroke risk that is much higher than that seen in Western populations.38 In AF patients with stable coronary artery disease, there is no evidence that adding APT to OAC reduces stroke/ systemic embolism, death, or MI. However, the risk of majorbleeding and ICH is substantially increased with the addition of APT to OAC. 