Another limitation of prediction scales for hemorrhage is that several of their components such as age and hypertension are also risks for cardioembolic stroke. Selecting Treatment to Reduce Stroke Risk in Patients With AF Adjusted-dose warfarin has generally been the treatment of choice for patients at high risk for cardioembolic stroke and acceptably low risk of hemorrhagic complications, particu- larly intracranial hemorrhage. Treatment with adjusted-dose warfarin (target INR, 2 to 3) robustly protects against stroke (RR reduction, 64%; 95% CI, 49 74), virtually eliminating the excess risk of ischemic stroke associated with AF if the intensity of anticoagulation is adequate and reducing all-cause In addition, anticoagu- lation reduces stroke severity and poststroke mortality.386 388 Compared with aspirin, adjusted-dose warfarin reduces stroke Three newer oral anticoagulants have been approved in the United States for stroke prevention in patients with nonvalvu- lar AF: the direct thrombin inhibitor dabigatran (dosed at 150 mg twice daily in patients with creatinine clearance 30 mL/ min) and the direct factor Xa inhibitors rivaroxaban (20 mg once daily for patients with creatinine clearance 50 mL/min) and apixaban (5 mg twice daily for patients with no more than 1 of the following characteristics: age 80 years, serum creati- nine 1.5 mg/dL, or body weight 60 kg). Clinical trial data and other information for these agents were recently reviewed in an AHA/American Stroke Association science advisory390 and are briefly summarized here. The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial391 randomized 18113 patients to dabi- gatran 150 mg or 110 mg twice daily or adjusted-dose war- farin (target INR, 2 to 3). 