See Figure 1 and 2 legends for expansion of other abbreviations. 1150 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] simple bleeding scores that include fewer clinical parameters. Among VKA-treated patients, the nonconsideration of TTR would also mean that the HEMORR2HAGES, ORBIT, and ATRIA scores would all perform suboptimally in VKA-treated patients.118,119 Finally, bleeding risk assessment is dynamic, and should be formally reassessed and recorded at every patient contact. Indeed, follow-up HAS-BLED or delta HAS- BLED score was more predictive of major bleeding compared with baseline HAS-BLED or the simple determination of modi able bleeding risk factors.77 Recommendations 3. For patients with AF, bleeding risk assessment should be performed in all patients with AF at every patient contact and should initially focus on potentially modi able bleeding risk factors (Strong recommendation, low quality evidence). Remark: Modi able risk factors may include: Uncontrolled blood pressure, Labile INRs (in a patient taking VKA), Alcohol excess; Concomitant use of NSAIDs or aspirin, in an anticoagulated patient, bleeding tendency or predisposition (eg, treat gastric ulcer, optimize renal or liver function, etc). 4. For patients with AF, we recommend use of the HAS-BLED score to address modi able bleeding risk factors in all AF patients. Those potentially at high risk (HAS-BLED score 3) warrant more frequent and regular reviews or follow-up (Strong recommendation, moderate quality evidence). Remark: Given that bleeding risk is highly dynamic, attention to modi able bleeding risk factors should be prioritized during every patient contact or review. 5. In VKA-treated patients, we recommend use of the HAS-BLED score for bleeding risk assessment (Weak recommendation, low quality evidence). Remark: A high HAS-BLED score ($ 3) is rarely a reason to avoid anticoagulation. 