We suggest oral anticoagulation rather than aspirin (75 mg to 325 mg once daily) (Grade 2B) or combination therapy with aspirin and clopidogrel (Grade 2B). For patients who are unsuitable for or choose not to take an oral anticoagulant (for reasons other than concerns then the already small bene ts of antithrombotic therapy (number needed to treat for 1 year to prevent one nonfatal stroke of 500 for aspirin and 200 for VKA therapy) will be even smaller. For patients who do choose antithrombotic therapy, the potential choices are aspirin, dual antiplatelet therapy with aspirin and clopidogrel, or oral antico- agulation. For every 1,000 patients with a CHADS2 score of 0, treatment for 1 year with adjusted-dose VKA therapy or with combination aspirin and clopid- ogrel therapy compared with aspirin is anticipated to result in small reductions in nonfatal stroke and an increase in nonfatal major extracranial bleeding such that the net bene ts of either VKA therapy or dual antiplatelet therapy with aspirin and clopidogrel would be small, particularly given the possibility of declining stroke rates over time (Tables 5, 7). Recommendation 2.1.8. For patients with AF, including those with paroxysmal AF, who are at low risk of stroke (eg, CHADS2 score50), we suggest no therapy rather than antithrombotic therapy (Grade 2B). For patients who do choose antithrombotic therapy, we suggest aspirin (75 mg to 325 mg once daily) rather than oral anticoagulation (Grade 2B) or combination therapy with aspirin and clopidogrel (Grade 2B). Remarks: Patients who place an exceptionally high value on stroke reduction and a low value on avoid- ing bleeding and the burden associated with anti- thrombotic therapy are likely to choose antithrombotic therapy rather than no antithrombotic therapy. 