In addition, patients identi ed as high risk for bleeding should be scheduled for more frequent follow-up and monitoring. As noted in the Bleeding Risk in AF section, we make a consensus suggestion that the HAS-BLED score be used for this purpose, so those with a HAS-BLED score $ 3 can be identi ed as high risk for this reason. The nal decision point is to decide which OAC to use for stroke prevention. As noted in atrial tachycardia therapy and other approaches to stroke prevention, we recommend one of the NOACs (dabigatran, apixaban, edoxaban, or rivaroxaban) as rst line in patients with AF. These agents have not been compared head-to-head, and we therefore do not recommend one over the other. Local availability, cost, and patient comorbidities might Low stroke risk 0 in males 1 in females No antithrombotic treatment *Address modi able bleeding risk factors in all AF patients. High bleeding risk scores should not be used as a reason to withhold OAC. Calculate the HAS-BLED score. If HAS-BLED 3, address the modifiable bleeding risk factors and flag up patient for regular review and follow-up. Step 1 Identify low- risk patients Consider stroke prevention (ie, OAC) in all AF patients with 1 additional stroke risk factors* Begin NOAC (or VKA with high time in therapeutic range) Rationale: Step 1: CHA2DS2-VASc score has superior sensitivity and thus can identify low risk patients reliably (see Recommendations 1 and 2 for further rationale). Step 2: Higher bleeding risk scores lack specificity given the dynamic nature of bleeding risk. High risk scores should be used simply to identify potential modifiable factors and patients who may need more frequent follow-up. Step 3: We recommend NOACs as first line therapy for OAC. 