Discuss with the person that: for most people the benefit of anticoagulation outweighs the bleeding risk for people with an increased risk of bleeding, the benefit of anticoagulation may not always outweigh the bleeding risk, and careful monitoring of bleeding risk is important. [2021] 1.6.2 When deciding between anticoagulation treatment options: Discuss the risks and benefits of different drugs with the person and follow the Follow the recommendations on patient involvement in decisions about medicines in NICE's guideline on medicines adherence and patient decision aids in NICE's guideline on medicines optimisation. Take into account any contraindications for each drug and follow the guidance in the British National Formulary and the MHRA advice on direct-acting oral anticoagulants, in particular for advice on dosages in people with renal impairment, reversal agents and monitoring. [2021] 1.6.3 Offer anticoagulation with a direct-acting oral anticoagulant to people with atrial fibrillation and a CHA2DS2-VASc score of 2 or above, taking into account the risk of bleeding. Apixaban, dabigatran, edoxaban and rivaroxaban are all recommended as options, when used in line with the criteria specified in the relevant NICE technology appraisal guidance (see the NICE technology appraisal guidance on our topic page on embolism and thrombosis). [2021] 1.6.4 Consider anticoagulation with a direct-acting oral anticoagulant for men with atrial fibrillation and a CHA2DS2-VASc score of 1, taking into account the risk of bleeding. Apixaban, dabigatran, edoxaban and rivaroxaban are all recommended as options, when used in line with the criteria specified in the relevant NICE technology appraisal guidance (see the NICE technology appraisal guidance on our topic page on embolism and 1.6.5 If direct-acting oral anticoagulants are contraindicated, not tolerated or not suitable in people with atrial fibrillation, offer a vitamin K antagonist. See the section on self-monitoring and self-management of vitamin K antagonists. [2021]. 