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Background: We aim to derive and validate a score that predicts early ischemic events or major hemorrhage in acute stroke patients with atrial fibrillation (AF).Methods and results: The derivation cohort consisted of 854 patients with acute ischemic stroke and AF (mean age 76.3 y, 46.6% M) included between January 2012 and March 2014. Older age (HR 1.06 for each additional year, p=0.0025) and severe atrial enlargement (HR 2.05, p= 0.027) resulted being predictors for recurrent ischemic event (stroke, TIA, systemic embolism) within 90 days from acute stroke. Small infarct size (≤1.5 cm) was inversely correlated with both severe bleeding (HR 0.39, p=0.03) and recurrent ischemic events (HR 0.44, p=0.01). Considering the magnitude of the effect, we assigned 2 points to age ≥80 y; 1 point to 70-79 y; 1 point to presence of ischemic index lesion >1.5 cm; 1 point to severe atrial enlargement (ALESSA score). An increase in this score was associated with recurrent ischemic event but not major hemorrhage. A logistic regression with the ROC graph procedure (C-statistic) showed an area under the curve of 0.697 (0.632-0.763), p=0.0001 for ischemic outcome event and 0.585 (0.493-0.678), p=0.47 for major hemorrhage. On multivariate analysis, ALESSA >2 was associated with recurrent ischemic event (OR: 2.5, 95% CI 1.4-4.4, p=0.001) but not major hemorrhage (OR: 1.1, 95% CI 0.5-2.4, p=0.9). The validation cohort included 994 patients with acute stroke and AF (mean age 75.8 y, 46.0% M) included between April 2014 and June 2016. Also in this cohort, a higher ALESSA score was associated with recurrent ischemic event but not major hemorrhage. Logistic regression with the ROC graph procedure showed an area under the curve of 0.646 (0.529-0.763), p=0.009 for recurrent ischemic event and 0.407 (0.275-0.540), p=0.14 for major hemorrhage. On multivariate analysis, ALESSA >2 barely lacked being significantly correlated with recurrent ischemic event (OR: 2.07, 95% CI 0.93-4.67, p=0.07).Conclusions: A higher ALESSA score is associated with a higher risk of recurrent ischemic event but not with major hemorrhage. Therefore, patients with acute stroke and AF and an ALESSA score >2 may be candidates for early anticoagulation treatment. Further validations of this schema need to be performed.