(Partly reproduced with permission from Zulki y et al.103 ) a Score for each variable in ABC score is based on a nonogram (see reference100 ). b Bleeding event in original derivation cohort. c At 3 months. chestjournal.org Concomitant Medication Predisposing to Bleeding: Nonessential use of concomitant antiplatelet drugs and NSAIDs should be avoided since these medications increase the risk of bleeding in patients receiving OACs. Where concomitant antiplatelet therapy (APT) is necessary (ie, postcoronary stent implantation), the duration of combination OAC and antiplatelet drugs should be kept to the minimum.92 Since antiplatelet drugs/NSAIDs are widely available over-the-counter, patients need to be made aware of the bleeding risk associated with their use in combination with OAC. Alcohol Intake: Excessivealcoholintake(chronicorbinge- drinking) increases the risk of bleeding predominantly due to the risk of trauma, but in chronic alcohol abuse through poor medication adherence, hepatic and variceal disease. OACs should not initiated among patients consuming alcohol in excess > 14 U/week. There is no clear de nite thresholdwherebleedingriskisincreased.Patientsalsoneed to be made aware of the potential dangers associated with excessive alcohol consumption in combination with OAC/ antithrombotic therapy. Lifestyle Factors: Avoidance of work and/or leisure activities that have the potential to cause serious trauma (eg, contact sports, rock-climbing, occupations working at height or operating heavy machinery) should be advised. Bridging Periods Off Anticoagulation: Interruption of OAC should be avoided to reduce stroke risk since the majority of cardiovascular procedures (eg, pacemaker implantation or percutaneous coronary intervention [PCI]) can be safely performed on OAC. Bridging (ie, stopping OAC and providing anticoagulation cover with heparin) should be used in patients with mechanical heart valves but does not appear to be otherwise Appropriate Choice of OAC: Choice of OAC should be made on an individual basis after stroke and bleeding risk assessment and discussion with the patient. 