Since physicians do not want to cause harm, the question is, how do we better understand this dilemma with all of these individuals still being treated with aspirin?  How do we optimize benefit and reduce the risk for our patients with AFib?  This means balancing the benefit of inhibiting thrombosis versus the risk of bleeding and hemorrhage, but the all-important point for physicians should be the magnitude of the risk of stroke.

One fact that I always remind those with whom I work is that the 30-day mortality rate for strokes caused by AFib is 24%, and if there is any one statement physicians should remember, it is this one. 

In addition, multiple studies have shown that strokes caused by AFib are large.  The emboli caused by AFib are large, and when they embolize from the heart or the left atrial appendage or left atrium, they don't portend a good prognosis.  The 24% mortality rate means that almost 1 in 4 individuals will die of this form of stroke within 30 days. 

Therefore physicians must remember the magnitude of the risk when you are talking with your patient about which agent might be best.