In end-stage renal disease (CrCl < 15 mL/min or dialysis-dependent), we suggest that individualized decision-making is appropriate (Ungraded consensus- based statement). 54. In end-stage renal disease (CrCl < 15 mL/min or dialysis-dependent, we suggest using well-managed VKA with TTR > 65-70% (Ungraded consensus-based statement). Remark: NOACs should generally not be used, although in USA, apixaban 5 mg bid is approved for use in AF patients receiving hemodialysis. Remark: In patients with CKD who initiate OAC, concomitant antiplatelet therapy including low-dose aspirin is likely to substantially elevate bleeding risk and should be used very judiciously. 55. In patients with AF at high risk of ischemic stroke who have absolute contraindications for OAC, we suggest using LAA occlusion (Weak recommendation, low quality evidence). Remark: When taking into account LAAO as a potential option, the risk of bleeding related to antiplatelet agents that need to be prescribed in the rst months has to be considered and the possibility to use NOACs. 56. In AF patients at risk of ischemic stroke undergoing cardiac surgery, we suggest surgical exclusion of the LAA for stroke prevention, but the need for long-term OAC is unchanged (Weak recommendation, low quality evidence). 57. In AF patients taking warfarin without high risk of thromboembolism or who do not have a mechanical valve, we suggest preoperative management without bridging (Weak recommendation, low quality evidence). 58. In AF patients on antithrombotic prophylaxis with warfarin with a high risk of thromboembolism or with a mechanical valve, we suggest preoperative management with bridging (Weak recommendation, low quality evidence). 59. In AF patients on antithrombotic prophylaxis with an NOAC, we suggest preoperative management without bridging (Weak recommendation, low quality evidence). 60. 