In January 2019, a paper by Rodwin et al titled: Variation in the use of warfarin and direct oral anticoagulants in atrial fibrillation and associated cost implications was published in this journal.1 While the published manuscript was well written, timely, and important, it ignored a major component of costs in this arena, both in the main text and in the limitations section. That is, the cost and consequences of strokes and intracranial bleeds. The manuscript focused on “the national trends in anticoagulation use for atrial fibrillation” and reported “a rapid increase in the use of DOACs [direct oral anticoagulants], significant disparities in anticoagulation use and choice of anticoagulant based on sociodemographic and clinical risk factors, and an increase in the overall and out-of-pocket costs for anticoagulants corresponding to the increased use of DOACs.