In AF patients on antithrombotic prophylaxis with an NOAC, we suggest preoperative management without bridging (Weak recommendation, low quality evidence). 60. In AF patients who have previously refused OAC, we suggest reinforcing educational messages at each contact with the patient and revisit OAC treatment decisions (Ungraded consensus-based statement). Remark: Patient and physician treatment objectives often differ signi cantly and it is important to elicit from the patient what outcomes of OAC treatment are important to them. Remark: Explain the risk of stroke and bene t/risks of treatment in terms the patient can understand and signpost the patient to appropriate educational resources. Introduction Atrial brillation (AF) is the most common sustained cardiac arrhythmia, with an increasing prevalence and incidence with age. In adults aged > 40 years, there is a 1 in 4 lifetime risk of developing AF, with incident AF commonly related to various associated cardiovascular and noncardiovascular risk factors. AF without associated valvular heart disease (so-called nonvalvular AF ) is associated with a vefold increase in stroke risk (approximately 5% per year), but this risk is dependent on the presence of various stroke risk factors.1 Many of the risk factors leading to incident AF are also risk factors for ischemic stroke, and the promotion of an integrated or holistic approach to AF management is needed, incorporating stroke prevention, addressing symptoms and risk factor management.2 Stroke prevention is the principal priority in the holistic approach to AF management.1 Even since the last edition of the CHEST guidelines published in 2012,3 there have been substantial developments in AF thromboproprophylaxis, whether with regard to risk assessment, antithrombotic drugs, or nondrug approaches. It is clear that AF should not be considered in isolation, at the stage of detection, prevention, or treatment. 