These 2 trends tend to have opposing effects on the tipping point at which the benefits of anticoagulation outweigh its risks: A lower stroke risk argues for more limited use of antico- agulation, and safer agents argue for more extensive use.418 On the basis of the decreasing risk of AF-related stroke, the 2012 American College of Chest Physicians evidence-based suggested that patients with nonrheu- matic AF at low stroke risk (ie, CHADS2 =0) be treated with no therapy rather than any antithrombotic agent (American College of Chest Physicians grade 2B; ie, weak recommenda- tion, moderate evidence); for those patients preferring anti- thrombotic treatment, aspirin rather than anticoagulation was recommended (grade 2B). These guidelines also favored oral anticoagulation rather than antiplatelet therapy for those at moderate risk (ie, CHADS2 =1; grade 2B) and for those at high risk (ie, CHADS2 2; American College of Chest Physicians grade 1B, ie strong recommendation, moderate evidence) and the use of dabigatran (the only approved newer anticoagulant when the guidelines were formulated) rather than warfarin as oral anticoagulant (grade 2B). For patients in these groups who select antiplatelet rather than anticoagulant therapy, the guidelines recommended combination aspirin plus clopido- grel rather than aspirin alone (grade 2B). Of these clinical sce- narios, the greatest uncertainty surrounds the management of patients at moderate risk (CHADS2 =1). A large cohort study did not find net clinical benefit of warfarin for AF patients with a CHADS2 score of 1,417 and a decision-analysis model predicted that anticoagulation would be beneficial in this group only when the lower risk of ICH associated with the newer agents was assumed.418 Most guidelines have not explicitly incorporated risk for anticoagulant-related hemorrhagic complications, largely because of the paucity of precise data on the risk of bleeding. 