Verheugt FWA, et al. - A total of 39,679 adults with newly diagnosed atrial fibrillation and ≥ 1 investigator-defined stroke risk factor were recruited in GARFIELD-AF between March 2010 and September 2015 to assess the outcomes in patients with newly diagnosed atrial fibrillation and a history of acute coronary syndromes. A greater adjusted risk of stroke/systemic embolism, major bleeding, all-cause mortality, cardiovascular mortality, and new acute coronary syndromes was observed in those with prior acute coronary syndromes. In evaluating those who had antithrombotic therapy in the acute coronary syndromes vs no acute coronary syndromes groups, most patients received oral anticoagulation (OAC) ± antiplatelet therapy (AP), however, AP therapy was seen more often in the acute coronary syndromes group, either alone or with OAC. Fewer patients in the acute coronary syndromes group received OAC with or without AP therapy amongst those with moderate/high risk for stroke/systemic embolism. The majority with a HAS-BLED score ≥ 3 were on AP therapy. Prior acute coronary syndromes correlated with worse 2-year results and a higher likelihood of undertreatment with OAC, while two-thirds of patients received AP therapy in GARFIELD-AF. Even after adjusting for all risk factors, major bleeding was more prevalent with previous acute coronary syndromes.