This seems unlikely in patients who are not under- going stent placement and, thus, where there is no concern regarding stent thrombosis. Given the lack of direct evidence and mindful of the principle to rst do no harm, we do not advocate the use of triple therapy in patients with AF who experience ACS but do not receive an intracoronary stent. However, patients placing a high value on MI and stroke reduc- tion and a low value on avoiding bleeding may opt for an initial period of triple therapy (eg, 3-6 months) followed by warfarin plus aspirin. Recommendation 3.3. For patients with AF at intermediate to high risk of stroke (eg, CHADS2 score of 1 or greater) who experience an acute coronary syndrome and do not undergo intracoronary stent placement, we suggest, for the rst 12 months, adjusted- dose VKA therapy (INR 2.0-3.0) plus single anti- platelet therapy rather than dual antiplatelet therapy (eg, aspirin and clopidogrel) or triple therapy (eg, warfarin, aspirin, and clopidogrel) (Grade 2C). After the rst 12 months, antithrom- botic therapy is suggested as for patients with AF and stable coronary artery disease (see sec- tion 3.1). For patients with AF at low risk of stroke (eg, CHADS2 score of 0), we suggest dual anti- platelet therapy (eg, aspirin and clopidogrel) rather than adjusted-dose VKA therapy (INR 2.0-3.0) plus single antiplatelet therapy or tri- ple therapy (eg, warfarin, aspirin, and clopid- ogrel) (Grade 2C). After the rst 12 months, antithrombotic therapy is suggested as for patients with AF and stable coronary artery disease (see section 3.1). 