Do population studies confirm the benefit of oral anticoagulation in atrial fibrillation demonstrated in clinical trials?

Atrial fibrillation (AF) is associated with a significant morbidity and mortality, mainly due to an increased risk of thromboembolic stroke. Several large randomized trials have demonstrated the efficacy of oral anticoagulation to reduce this risk of ischemic events in patients with non-valvular AF. Despite the translation of these results into clear practice guidelines, oral anticoagulation remains underused. This reflects doubts about the real effectiveness of oral anticoagulation in daily practice. This paper gives an overview of the available evidence of the effectiveness of oral anticoagulation in population studies and tries to identify some remaining barriers in the prescription of oral anticoagulation in real life.