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March 21, 2017

Postapproval Observational Studies of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation

Author Affiliations
  • 1School of Medicine, Belgrade University, Belgrade, Serbia
  • 2Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
  • 3University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom
JAMA. 2017;317(11):1115-1116. doi:10.1001/jama.2017.1152

The pivotal randomized clinical trials (RCTs) of non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) established the efficacy and safety of these drugs for patients with AF without mechanical prosthetic heart valves or significant (rheumatic) mitral valve stenosis.1 A clinical trial setting with strict inclusion and exclusion criteria was needed to obtain high-quality scientific evidence on the effects of NOACs compared with standard care (ie, warfarin), but these results in highly selected trial cohorts may not be fully applicable to a diversity of patients or clinical circumstances encountered in daily practice.