Anticoagulants are recommended for stroke prevention in atrial fibrillation (AF), unfortunatly they also increase the risk of bleeding. For this reason, physicians face benefit-risk trade-offs when prescribing anticoagulants to AF patients. Although the unmet medical need for safer anticoagulants has been documented, the actual patients and physicians preferences for outcomes associated with anticoagulants are yet to be documented. OBJECTIVES: To quantify Japanese patients and physicians preferences for benefits and risks associated with the use of anticoagulants in AF and to enable cross-patient and physician comparison. METHODS: Patients ≥45 years old with a self-reported physician diagnosis of AF, and board-certified internists, cardiologists, neurologists and neurosurgeons currently treating AF patients were invited to complete a web-enabled, choice-format conjoint survey that included a series of trade-off questions. Each trade-off question included a pair of hypothetical anticoagulants defined by therapy-induced changes in the risk of stroke, myocardial infarction, embolism, and bleeding. In addition, respondents were asked to revisit their anticoagulant choice based on the risk of all-cause death and on the monitoring requirement. Patients were asked to choose anticoagulants for themselves, while physicians chose anticoagulants for virtual patients. Random-parameters logit was used to estimate a relative preference weight for the risk of each event based on respondents’ choices in the trade-off questions. RESULTS: A total of 152 patients and 164 physicians completed the survey. Overall patients and physicians considered all-cause death to be the least desirable outcome. Among non-fatal outcomes, patients considered the risk of disabling stroke to be 2.6 times more important than extra-cranial major bleeding and 16 times more important than non-major clinically relevant bleeding compared to 1 time and 2.7 times for physicians.   CONCLUSIONS: Japanese patients and physicians have different preferences for non-fatal outcomes associated with anticoagulants, with patients willing to tolerate a greater risk of bleeding for stroke prevention than physicians.