Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and anticoagulation is one of the core strategies in the treatment of AF; therefore, patients with AF are the mainstay of the use of NOACs. To date, several large-scale prospective randomized controlled trials have confirmed the efficacy and safety of NOACs in the prevention of stroke or embolic events in patients with non-valvular AF. 2009, RE-LY trial: enrolled 18,113 cases, with a median follow-up of 2 years, showed that the anticoagulant efficacy of dabigatran etexilate was noninferior to, or even superior to, that of warfarin, and that total bleeding complications were less than those of warfarin. 2010. ROCKET-AF trial: 14,264 patients were enrolled, with a median follow-up of 707 days, and the results confirmed that the efficacy of rivaroxaban in stroke prevention was comparable to that of warfarin and did not increase the risk of bleeding in patients. 2011, ARISTOTLE trial: 18,201 patients were enrolled, with a median follow-up of 1.8 years, and the results demonstrated that the efficacy and safety of apixaban for the prevention of stroke in patients with non-valvular atrial fibrillation were superior to those of In 2011, the AVERROES trial: enrolled 5,599 patients with a mean follow-up of 1.1 years, comparing the efficacy and safety of apixaban versus aspirin for stroke prevention in patients with atrial fibrillation who were intolerant of, or had contraindications to, warfarin, was terminated prematurely after an interim follow-up analysis demonstrated that apixaban was significantly more efficacious than aspirin. The above evidence-based medical results suggest that NOACs are at least noninferior to warfarin in efficacy but safer in preventing stroke or embolic events in patients with nonvalvular atrial fibrillation. The results of the RELY-ABLE trial, recently published in Circulation, which looked at patients who continued taking dabigatran etexilate after the RE-LY trial (5,851 patients, with a median of 2.3 years of continued follow-up), showed that the risk of ischemic stroke and major bleeding events in patients who continued to take dabigatran etexilate was comparable to that in the RE-LY trial, confirming for the first time that long-term use of NOACs for the prevention of stroke or embolic events in patients with nonvalvular atrial fibrillation is at least as effective as warfarin, but with a higher safety profile. For the first time, the efficacy and safety of long-term dabigatran etexilate use has been demonstrated. In addition, the large registry studies GLORIA and GARFIELD, with longer follow-up, are ongoing, and we look forward to receiving “real world” information on the use of NOACs for the prevention of thromboembolic events in non-valvular atrial fibrillation. Based on this clinical evidence, NOACs have been gaining ground in AF treatment guidelines in recent years, with the 2010 European Society of Cardiology (ESC) AF treatment guidelines first citing the RE-LY and AVERROES studies that had been published at that time, but not specifically recommending the use of NOACs for anticoagulation in AF. With the publication of the results of the ROCKET-AF and other trials, the 2011 update of the American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) guidelines for the treatment of atrial fibrillation recommended for the first time that patients with atrial fibrillation with risk factors for stroke or systemic embolism, who do not have implanted prosthetic heart valves or valvular disease that interferes with hemodynamics, and who do not have severe renal insufficiency [creatinine clearance (CrCl) <15 ml/min] or severe liver disease (affecting coagulation at baseline status), dabigatran can be used as an alternative therapy to warfarin for the prevention of stroke and systemic embolism (Recommendation Level I, Level of Evidence B). Subsequently, the ESC 2012 guidelines for the treatment of AF were updated to recommend that in patients with nonvalvular AF with indications for anticoagulation who are unfit or unwilling to anticoagulate with warfarin and who have no contraindications to NOACs, anticoagulation can be directly administered with any of the NOACs (Recommendation Class I, Level of Evidence B), or even with NOACs as the preferred oral anticoagulant (Recommendation Class IIa, Level of Evidence B). .