Remark: A high HAS-BLED score ($ 3) is rarely a reason to avoid anticoagulation. The individual modi able components of the score, when reviewed with the patient, can serve to ameliorate bleed risk Anti-Thrombotic Therapy and Other Approaches for Stroke Prevention The principal goal of OAC in AF is to reduce the risk of stroke and systemic embolism, while minimizing the incremental bleeding risk associated with OAC. Although these outcomes may be in part mechanistically related to lower risk of bleeding and ischemic stroke compared with therapies in the control arms, cardiovascular composite or survival outcomes presently do not re ect the primary rationale for therapy. Randomized Trials: VKAs Compared With Placebo or Control: In a meta-analysis of 2,900 subjects from 6 randomized trials, adjusted-dose warfarin was associated with a 64% relative risk reduction in stroke (95% CI, 49-74) (e-Table 12). The absolute risk reduction was 2.7% per year (from 4.5% per year in control subjects) in primary prevention subjects and 8.4% per year (from 12% per year in control subjects) in secondary Aspirin and APT Compared With Placebo or Control: In a meta-analysis of 8 trials of 4,876 subjects, APT compared with control or placebo was associated with a 22% (95% CI, 6-35) relative risk reduction in stroke The Stroke Prevention in AF (SPAF-I) study demonstrated decrease in risk of stroke from 6.3% per year in placebo subjects to 3.6% per year but a meta-analysis of 7 trials of 3,990 subjects found no signi cant bene t. SPAF-I was the only trial suggestive of a bene t for aspirin compared with placebo, but there was internal heterogeneity between the anticoagulation-eligible and anticoagulation-ineligible subgroups, and given the trial was stopped early, the effect size could have been exaggerated. 