Real-world evidence that supports RCT data is an important tool in the arsenal of evidence for
the therapeutic management of any condition. Head-to-head RCT data comparing NOACs (nonvitamin
K antagonist oral anticoagulants also called ‘new’ or ‘novel’ oral anticoagulants, or direct oral
anticoagulants) with each other are lacking. This review summarises and discusses the real-world
comparative effectiveness of NOACs and warfarin for preventing stroke, bleeding and mortality in
patients with non-valvular AF (atrial fibrillation), as recently described by multiple real-world evidence
publications such as Graham et al. in Am J Med.1 Supporting evidence from RCTs is also summarised.
The NOACs of interest for this summary are those that are currently funded in NZ, namely dabigatran
and rivaroxaban. Among patients with non-valvular AF with similar baseline characteristics, standarddose
NOACs were found to have a more favourable benefit-to-harm profile than warfarin, and among
NOACs, dabigatran appears to have a more favourable benefit-to-harm profile. This article was
supported by an educational grant from Boehringer Ingelheim.
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