Another large analysis of 3 Danish nationwide databases of 61,678 patients found that NOACs were at least as safe and effective as warfarin, with small but signi cant differences in risk of stroke, death, and bleeding across rivaroxaban, apixaban, and dabigatran.129 However, a new-user Food and Drug Administration Medicare analysis of 118,891 patients found that rivaroxaban compared with dabigatran had a statistical trend toward a decreased risk of stroke (HR, 0.81; 95% CI, 0.65-1.01) and signi cantly increased risk of intracranial (HR, 1.47; 95% CI, 1.32-1.67) and major non-intracranial (HR, Absolute risk differences were small (2.0-2.1 per 1,000 person-years) and well within a range vulnerable to confounding. Different Ethnic Groups: Asian AF patients have a higher risk of ICH compared with whites when VKAs The higher risk of bleeding on VKA in Asians vs non-Asians has also been observed in major clinical trials of NOACs,132 even though Asians received a lower intensity of anticoagulation with VKA.133 In a recent meta-analysis comprising 5 NOAC trials (RE-LY, ROCKET AF, Japanese Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation [J-ROCKET AF], Apixaban for Reduction of Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE], and Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation- Thrombolysis in Myocardial Infarction 48 [ENGAGE AF-TIMI 48]), the effects of NOACs vs warfarin in 1154 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] Asians vs non-Asians were compared.134 For standard- dose NOACs (dabigatran 150 mg, rivaroxaban 20 mg, apixaban 5 mg, and edoxaban 60 mg), the effect sizes of the primary ef cacy end point (stroke and systemic embolism) and the primary safety end point (major bleeding) were greater in Asians vs non-Asians. 