Although the use of the -VASc score has been validated only in several small studies of patients with AF and ACS, we believe it is reasonable to use this methodology to estimate the risk of systemic 4. A single-center prospective cohort study found that, as compared with triple therapy with clopi- dogrel, triple therapy with prasugrel was associ- ated with a higher incidence of Thrombolysis in Myocardial Infarction (TIMI) major or minor bleed- This finding was corroborated by the TRANSLATE-ACS (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study,S7.4-5 a mul- ticenter prospective cohort study of patients who underwent PCI for an acute MI. That study found that, as compared with triple therapy with clopi- dogrel, triple therapy with prasugrel was associ- ated with a higher incidence of BARC (Bleeding Academic Research Consortium) defined bleed- ing events. These events, however, were patient- reported bleeding events that did not require hospitalization. 5. WOEST was an RCT that showed that, as com- pared with triple therapy (aspirin, clopidogrel, and warfarin), double therapy with warfarin and clopidogrel was associated with fewer bleeding complications. WOEST, however, was not pow- ered to assess stent thrombosis.S7.4-3 Two other registry-based studies similarly showed that dou- ble therapy with warfarin and clopidogrel was not associated with higher risk of coronary isch- emia than triple therapy.S7.4-6,S7.4-7 Furthermore, a hospital-based retrospective cohort study found that double therapy with warfarin and ticagrelor had thrombotic and bleeding rates that were similar to those observed with triple The aforementioned studies were not based exclusively on patients with AF and ACS; patients with AF undergoing elective PCI for stable coronary artery disease were also included. 6. 