Anticoagulant treatment is the mainstay for stroke prevention in atrial fibrillation (AF); however, the increased risk of bleeding caused by anticoagulants requires considering benefit-risk tradeoffs in their use.  Patient and physician preferences for avoiding death, stroke and bleeding underlie these considerations and influence treatment decisions. OBJECTIVES: To quantify and compare US patient and physician preferences for benefits and risks associated with anticoagulants in AF. METHODS: Adult patients with a self-reported physician diagnosis of AF, and board-certified internists or cardiologists treating AF patients, completed a web-based, choice-format conjoint survey. Tradeoff questions in the survey included a pair of hypothetical anticoagulants defined by a risk profile including disabling and non-disabling stroke, myocardial infarction, embolism, and major and non-major clinically-relevant bleeding. Patients chose anticoagulants for themselves, while physicians chose anticoagulants for virtual patients. Random-parameters logit was used to estimate relative preference weights for the likelihood of experiencing outcomes. RESULTS: 186 patients (mean age 65.6) and 107 physicians completed the survey. Patients considered disabling stroke as the least desirable outcome, while physicians regarded death as least desirable.  Relative to the risk of disabling stroke, patients considered death 60% (95% CI 39%-80%) as important, and non-fatal major bleeding and non-major clinically-relevant bleeding 47% (28%-65%) and 17% (10%-23%) as important, respectively.  For physicians, relative to the risk of disabling stroke, death was 150% (82%-218%) as important, and non-fatal major bleeding and non-major clinically-relevant bleeding were 66% (47%-84%) and 14% (8%-20%) as important.  Non-fatal embolism and myocardial infarction were of intermediate importance between the two levels of bleeding for both groups.  CONCLUSIONS: US patient decisions on anticoagulant treatment in AF may be more motivated by avoiding strokes, while physicians may focus more on avoiding death.  The difference in perspective on relative importance of bleeding and stroke may lead to different benefit-risk assessments by patients and physicians.