Oral anticoagulation (OAC) is pivotal in preventing stroke in atrial fibrillation (AF), but its use poses inherent risks, notably an increased susceptibility to bleeding, especially in clinically complex patient phenotypes, including the elderly and those with multimorbidity, polypharmacy or frailty [1,2]. An informed clinical evaluation using well-validated contemporary evidence-based risk assessments for both thromboembolism and bleeding are needed [3].