The studies eliciting prefer- ences were small and used different methods and tools, and most included a sizeable proportion of participants who had previ- ously taken or were currently taking VKAs. Furthermore, there are inconsistencies across studies that often are dif cult to explain, leaving considerable uncertainty about average patient values. Nevertheless, to make our recommendations, we required an esti- mate of average patient values for the relevant outcomes so that we could judge whether the trade-offs between bene t and harm would favor one course of treatment over another. As described by Guyatt et al10 in this guideline, to obtain our estimates of average patient values, we have used ratings of key health states from participating guideline panelists informed by our systematic review of the relevant literature. The results of the panelist value rating exercise suggest that on average, patients would nd a typical nonfatal stroke (ischemic or hemorrhagic) approximately three times as aversive as a nonfatal major extra- cranial bleed (typically a GI bleed) and a typical nonfatal MI as aversive as a nonfatal major extracranial bleed. With the exception of the choice between VKA therapy and no therapy, the choice of one antithrombotic treatment over another for long-term stroke prevention in AF will not lead to differences in all-cause mortality (section 2). Thus, for these choices that are not expected to result in a difference in mor- tality, for every 1,000 patients treated for 1 year, if the number of nonfatal strokes prevented is less than one-third of the number of nonfatal major extracranial bleeds caused by a given antithrom- botic therapy, we have recommended against that intervention. 