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Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban, apixaban and edoxaban. Yet, despite these large trials, there remains limited power to examine certain end points and treatment effects in subgroups.
In a prespecified meta-analysis, the authors pooled trial-level data from the four existing phase-3 randomised clinical trials comparing a NOAC …