APTs antiplatelets; CKD-EPI Chronic Kidney Disease Epidemiology Collaboration; CrCl creatinine clearance; cTnT-hs high- sensitivity troponin T; CYP cytochrome P450; GDF-15 growth differentiation factor-15; INR international normalized ratio; NSAIDs nonsteroidal antiin ammatory drugs; SBP systolic blood pressure; vWF von Willebrand factor. See Figure 1 legend for expansion of other abbreviations. 1148 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] the patient would need to fall 295 times per year for the risk from falls to outweigh the bene ts of stroke In patients with cognitive impairment or dementia, OAC should only be withheld if there is no available caregiver who can guarantee medication adherence. Reversal of Biochemical Anomalies: Patients with anemia or reduced platelet count or function should be treated where possible to improve their hemoglobin or platelet count. Causes of renal impairment should be investigated and where possible reversed. 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. 