Patients with liver function abnormalities were generally excluded from the randomized trials, and especially where there is abnormal clotting tests, such patients may be at higher risk of bleeding on VKA, possibly less so on NOACs; in cirrhotic patients, ischemic stroke reduction may outweigh bleeding risk.96,97 Bleeding Risk Assessment: Since 2006, six risk scores have been developed and validated for the assessment of bleeding risk in AF populations.98-103 The number of risk factors included in the bleeding risk schemas varies considerably, from three100 and the score or weighting associated with each risk factor also differs Age and prior bleeding are included as risk factors in all 6 bleeding risk scores but different age cutoffs are utilized, with 3 scores employing age 75 years or to indicate greater bleeding risk. Following age and prior bleeding, the most prevalent bleeding risk factors included in the scores are anemia,69,99-102 renal or uncontrolled and and prior stroke98,99 or hepatic A variety of other risk factors, including are included only in one bleeding risk score. For a comprehensive review of bleeding risk factors in AF patients see Zulki y et al.103 The bleeding risk scores range in the simplicity of calculation and the cutoffs employed to indicate low, intermediate, and high risk of bleeding, and the prevalence of bleeding events reported in the validation cohorts (Table 3). 