A fifth NOAC, betrixa- ban, has not been approved by the FDA for use in patients with AF. Antithrombotic (anticoagulant com- bined with antiplatelet) therapy is discussed in Sec- Recommendations for Selecting an Anticoagulant Regimen Balancing Risks and Benefits Referenced studies that support new or modified recommendations are summarized in Online Data Supplements 1 and 2. COR LOE Recommendations I A For patients with AF and an elevated -VASc score of 2 or greater in men or 3 or greater in women, oral anticoagulants are recommended. Options include: Warfarin (LOE: A)S4.1.1-5 S4.1.1-7 Dabigatran (LOE: B)S4.1.1-8 Rivaroxaban (LOE: B)S4.1.1-9 Apixaban (LOE: B),S4.1.1-10 or Edoxaban (LOE: B-R)S4.1.1-11 MODIFIED: This recommendation has been updated in response to the approval of edoxaban, a new factor Xa inhibitor. More precision in the use of CHA2 -VASc scores is specified in subsequent recommendations. The LOEs for warfarin, dabigatran, rivaroxaban, and apixaban have not been updated for greater granularity as per the new LOE system. (Section 4.1. in the 2014 AF Guideline) The original text can be found in Section 4.1 of the 2014 AF guideline. Additional information about the comparative effectiveness and bleeding risk of NOACs can be found in Section 4.2.2.2. B B B B-R I A NOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) are recommended over warfarin in NOAC-eligible patients with AF (except with moderate-to-severe mitral stenosis or a mechanical heart NEW: Exclusion criteria are now defined as moderate-to-severe mitral stenosis or a mechanical heart valve. When the NOAC trials are considered as a group, the direct thrombin inhibitor and factor Xa inhibitors were at least noninferior and, in some trials, superior to warfarin for preventing stroke and systemic embolism and were associated with lower risks of serious bleeding. 