Data from NOACs trials are more reliable, because patients were randomized to treatment, the majority were double- blinded, and the quality of anticoagulation (such as TTR) was generally better than observational studies. The risk of major bleeding on NOACs, especially the low-dose regimen (dabigatran 110 mg and edoxaban 30 mg), was generally lower than that on warfarin, except in the Rivaroxaban Once daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial.73 Risk Factors for Bleeding With NOAC, VKA, and Antiplatelet Therapy: Numerous risk factors for bleeding among AF patients receiving antithrombotic therapy have been identi ed and incorporated into bleeding risk scores (see section on Use of Bleeding Risk Scores). Bleeding risk varies from person to person depending on their pre-existing comorbidities, current antithrombotic regimen and adherence, concomitant medication, and lifestyle choices. Many of these factors cannot be altered but some are modi able or potentially modi able (Fig 2). In order to reduce antithrombotic treatment-associated bleeding, it is important to recognize that bleeding risk is also dynamic and should be reassessed at every patient review. While modi able bleeding risk factors that can be changed or managed should clearly be addressed as part of a holistic approach to AF patient assessment and management, nonmodi able bleeding risks are important drivers of bleeding events when occurring synergistically with An approach to bleeding risk assessment soley based only on modi able bleeding risk factors is an inferior assessment strategy compared with use of a formal bleeding risk score.78-80 BP Control: Good control of BP is vital to reduce the risk of stroke and is essential to decrease the risk of bleeding on antithrombotic therapy; adherence to current guidelines on the management of hypertension should be followed. 