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Once the principle of “First, diagnose” (as discussed in Figure 6) is accepted, then regardless of which anticoagulation therapy is prescribed or which physicians are prescribing it, it is important for physicians to understand the distribution of benefit versus risk. As shown in the Figure, a detailed study with one of the NOACs, rivaroxaban in ROCKET AF, found a clear benefit with the NOAC versus warfarin. The important point for physicians, however, is that the benefit in terms of events avoided per 100 patient-years applies in patients <75 and ≥75 years of age.[121] The efficacy here is higher in older versus younger patients, but the bleeding is higher as well. Nevertheless, the net overall clinical benefit shows positive results for both the older and younger patients, and so the moral must be: First, diagnose, then treat!
French WJ. Am J Med 2013; 126: 00-00.
[121] Patel MR, Mahaffey KW, Garg J, et al; the ROCKET AF Steering Committee, for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-891.