Oral anticoagulants studied for intermediate stroke risk in atrial fibrillation

A new clinical trial, known as the SINGLE-AF trial, has investigated the effectiveness of direct oral anticoagulants (DOACs) for patients with atrial fibrillation who fall into the intermediate-risk category for stroke. While high-risk patients are routinely prescribed blood thinners and low-risk patients often are not, the benefits for those in the middle have lacked randomized trial data.

Led by Professor Boyoung Joung at Yonsei University, the study followed 1,803 participants across 18 medical centers in South Korea for two years. Participants were randomly assigned to either receive no anticoagulant or a regimen of either apixaban or rivaroxaban. The findings, presented at ESC Congress 2026 and published in the New England Journal of Medicine, aim to address the clinical uncertainty regarding whether modern DOACs improve outcomes for this specific patient group without causing excessive bleeding risks.