In 1,803 people with atrial fibrillation at intermediate stroke risk, a direct oral anticoagulant cut the combined event rate by 69% at 24 months

What the research found

Study (open-label randomized trial). Boyoung Joung of Yonsei University and colleagues presented SINGLE-AF at ESC Congress 2026 and in the New England Journal of Medicine (2026; 395(12):1155; doi 10.1056/NEJMoa2607978; ScienceDaily 27 September 2026). At 18 centers in South Korea, 1,803 people with atrial fibrillation and an intermediate stroke score (CHA2DS2-VASc of 1 in men or 2 in women) were assigned to a direct oral anticoagulant (apixaban 5 mg twice daily or rivaroxaban 20 mg once daily) or to no anticoagulation. At 24 months the combined endpoint of stroke, systemic embolism, major bleeding, and cardiovascular death occurred in 0.5% on anticoagulation versus 1.5% without it (hazard ratio 0.31; 95% CI 0.10 to 0.94; p=0.028). Ischemic stroke was 0.1% versus 1.1%. Major bleeding was 0.3% versus 0.5%. Absolute event counts are small. The trial was open-label. Educational notes. Starting or stopping anticoagulation is a clinician decision. This is not a reason to begin a prescription from a headline.

Evidence level: Clinical trial. This is among the stronger kinds of evidence, but one study rarely settles a question.

Read the original at Yonsei University / European Society of Cardiology / New England Journal of Medicine