There were no studies directly comparing the direct-acting anticoagulants head-to-head but indirect comparisons based on the clinical evidence showed that the different direct-acting oral anticoagulants offered different benefits depending on the outcome considered. When all these outcomes were combined in the cost-effectiveness analysis, apixaban was the most clinically effective and cost-effective anticoagulant based on UK drug tariff prices at the time. However, the committee had concerns over the lack of head-to-head comparisons, differences in the study populations and uncertainties in the economic model. Based on the evidence and their experience, the committee decided not to recommend one direct-acting oral anticoagulant over the others, but instead to emphasise that treatment should be tailored to the person's clinical needs and preferences. Each anticoagulant has different risks and benefits that should be considered and fully discussed with the person as part of informed shared decision making. The committee highlighted that the choice might be affected by factors such as renal impairment and swallowing difficulties, and that healthcare professionals should refer to the BNF for advice on contraindications and cautions. They also stressed the importance of adherence and factors that might affect this, such as dosing frequency, when making the decision. If direct-acting oral anticoagulants are not suitable, for example in people with antiphospholipid syndrome, the committee agreed that a vitamin K antagonist should be offered. For people already established and stable on a vitamin K antagonist, the committee agreed that the benefits of changing to a direct-acting anticoagulant need to be discussed. Therefore, the risks and benefits of changing medication, the person's time in therapeutic range and the person's preferences should be explored at their next routine appointment. The committee agreed that the existing thresholds for the CHA2DS2-VASc score threshold for anticoagulation are in line with current practice. 