The balance of bleeding risk versus benefit of stroke risk reduction from oral anticoagulation favors earlier initiation in the set- ting of TIA when no cerebral infarction is present. The relative safety of earlier anticoagulation in TIA is in contrast to the recommended delay with stroke (particularly large stroke), in which cerebral infarction can disrupt the blood brain barrier and increases the risk of hemorrhage with initiation of anticoagulation. 8. In patients with stroke in the setting of nonvalvular AF, the left atrial appendage is the location of identi- fied thrombus 90% of the time.432 This observation gave rise to the concept of left atrial appendage closure to reduce the risk of stroke from AF. The Watchman device is a plug-style device placed in the ostium of the left atrial appendage to occlude it and prevent thromboembolism. It was studied in the randomized PROTECT AF trial (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) and PREVAIL trial (Prospective Randomised Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), as well as the nonrandomized CAP (Continued Access Registry), demonstrating non- significant numerically greater thrombotic risk with the device but lower bleeding risk and over- all net benefit.433 436 The Watchman device is the only currently available device with US Food and Drug Administration approval for left atrial append- age closure. Other devices to close the left atrial appendage are under investigation. Current prac- tice based on clinical trial design involves short- term (1.5 months) use of oral anticoagulation after Watchman device placement to reduce the risk of device-related thrombus followed by 4.5 months of DAPT. 