Patients with stroke or TIA in the setting of AF are at increased risk of recurrent ischemic stroke and at risk for ICH. Recurrent ischemic stroke risk is 0.5% per day to 1.3% per day in the first 14 days, whereas the rate of symptomatic hemorrhagic transformation after stroke ranges substantially, depending on the use of thrombolytics, with rates of 6% to 21% and 1% to 7% in the thrombolytic and placebo arms, respectively, across multiple tri- als of thrombolytic therapy.428,448 Anticoagulation reduces the risk of recurrent ischemic stroke but increases the risk of cerebral hemorrhage dur- ing the acute poststroke phase.429,449 Patients with larger cerebral infarcts are at greater risk for hemorrhagic transformation and worse bleeding with early initiation of anticoagulation430 ; thus, it is reasonable to delay initiation of oral anticoagula- tion for 14 days after stroke onset in that setting. Although there is no uniformly accepted definition of a large cerebral infarction, accepted defini- tions have included National Institutes of Health Stroke Scale (NIHSS) score >15450 and lesions involving complete arterial territory or >1 arterial Moreover, patients with early signs of hemorrhage on neuroimaging are at highest risk of further intracerebral bleeding and should delay initiation of oral anticoagulation to allow healing of the blood brain barrier.451 CLINICAL STATEMENTS AND GUIDELINES Kleindorfer 7. Patients who have a TIA rather than stroke in the setting of AF are at relatively low risk for intra- cranial hemorrhage but remain at increased risk for recurrent stroke. The balance of bleeding risk versus benefit of stroke risk reduction from oral anticoagulation favors earlier initiation in the set- ting of TIA when no cerebral infarction is present. 