{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:43:50Z","timestamp":1780980230541,"version":"3.54.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006603","name":"BMBF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006603","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010447","name":"DZHK","doi-asserted-by":"publisher","award":["81X2800182"],"award-info":[{"award-number":["81X2800182"]}],"id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022274","name":"Daiichi Sankyo Europe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["633196"],"award-info":[{"award-number":["633196"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AFFECT-EU","award":["847770"],"award-info":[{"award-number":["847770"]}]},{"name":"MAESTRIA","award":["965286"],"award-info":[{"award-number":["965286"]}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["AA\/18\/2\/34218"],"award-info":[{"award-number":["AA\/18\/2\/34218"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"publisher","award":["509167694"],"award-info":[{"award-number":["509167694"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010447","name":"DZHK","doi-asserted-by":"publisher","award":["81Z0710116"],"award-info":[{"award-number":["81Z0710116"]}],"id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010447","name":"DZHK","doi-asserted-by":"publisher","award":["81Z0710110"],"award-info":[{"award-number":["81Z0710110"]}],"id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with device-detected atrial fibrillation (DDAF) have a lower stroke risk than those with ECG-diagnosed AF, requiring careful evaluation of oral anticoagulation benefits vs. its inherent bleeding risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>An unmatched win ratio analysis was performed of the NOAH-AFNET 6 trial dataset, using components of the primary efficacy and safety outcomes of the trial. The primary analysis used this hierarchical order: (1) all-cause death, (2) stroke, (3) systemic or pulmonary embolism\/myocardial infarction, and (4) major bleeding. Two additional analyses replaced all-cause death with cardiovascular death or included patient-reported outcomes. Win odds were calculated to account for undecided comparisons. Among 2534 patients 77 \u00b1 7 years old, 947 (37%) women, median CHA2DS2-VA score 3 [interquartile range (IQR), 3\u20134], median follow-up 21 months (IQR, 10\u201338) 1 605 280 win ratio pairs were analyzed. The win ratio comparing edoxaban to no anticoagulation was 0.87 (95% CI: 0.68\u20131.10; P = 0.23). Most comparisons resulted in no clear winner (undecided pairs 84.9%). In the remaining comparisons, edoxaban won in 46% of the cases, placebo in 54%. Death and major bleeding were the most common events. The win odds was 0.98 (95% CI: 0.94\u20131.01; P = 0.23).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This hypothesis-generating win ratio analysis, integrating death, thrombotic events, and major bleeds with and without quality of life, did not find an advantage of anticoagulation with edoxaban over no anticoagulation in patients with DDAF. The most common events were death and major bleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf087","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T11:54:49Z","timestamp":1755172489000},"page":"1351-1358","source":"Crossref","is-referenced-by-count":3,"title":["Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: a win ratio analysis of the NOAH-AFNET 6 trial"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-1341","authenticated-orcid":false,"given":"Nina","family":"Becher","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf , Martinistr. 52, Hamburg 20246 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/Luebeck , Postdamer Str. 58, Berlin 10785 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"K\u00f6llner","sequence":"additional","affiliation":[{"name":"Faculty of Electrical Engineering and Computer Science, Stralsund University of Applied Sciences , Stralsund 18435 ,","place":["Germany"]},{"name":"Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf , Hamburg 20246 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-2904","authenticated-orcid":false,"given":"Emanuele","family":"Bertaglia","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Camposampiero Hospital\u2014AULSS Euganea , Padua 35012 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"Blomstrom-Lundqvist","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Uppsala University , Uppsala 75185 ,","place":["Sweden"]},{"name":"Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, \u00d6rebro University , \u00d6rebro 70182 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9145-6887","authenticated-orcid":false,"given":"Axel","family":"Brandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Esbjerg Hospital\u2014University Hospital of Southern Denmark , Esbjerg 6700 ,","place":["Denmark"]},{"name":"Department of Regional Health Research, University of Southern Denmark , Esbjerg 6700 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8599-808X","authenticated-orcid":false,"given":"Vincent","family":"Beuger","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation NETwork (AFNET) , Muenster 48149 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Fernando Fonseca Hospital , Amadora 2720-276 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Chlouverakis","sequence":"additional","affiliation":[{"name":"Biostatistics Lab, School of Medicine, University of Crete , Heraklion 71003 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9867-2582","authenticated-orcid":false,"given":"Gheorghe-Andrei","family":"Dan","sequence":"additional","affiliation":[{"name":"Academy of the Romanian Scientists, \u2018Carol Davila\u2019 University of Medicine , Bucharest 050474 ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Dichtl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University , Innsbruck 6020 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Paderborn 33098 ,","place":["Germany"]},{"name":"Otto-von-Guericke Universit\u00e4t Magdeburg , Magdeburg 39106 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris R","family":"de Groot","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam , Amsterdam 1105 AZ ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieven Nils","family":"Kennes","sequence":"additional","affiliation":[{"name":"Department of Economics and Business Administration, University of Applied Sciences Stralsund , Stralsund 18435 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John 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