• Stroke

Most therapeutic interventions quickly show their real benefits in certain patient groups and absence of benefits or even harm in others. That leaves a grey zone in between that gives rise to opinions and often heated discussions on where to draw the line between indication or not. For conditions that affect large groups of patients with chronic illnesses, the drawing line may be different in primary versus secondary care settings. One of such highly disputed grey zones is on the threshold to start oral anticoagulant therapy in patients with atrial fibrillation (AF). Only scientific data can help to visualise the division line more clearly, to narrow down the grey area and to abate opinionated discussions. That is exactly what the authors of an article in this issue have tried to do.1 They report on the net clinical benefit of anticoagulation with vitamin-K antagonists (VKAs) in real-world patients with AF, both in primary and secondary care. But do their data bring us closer to the answer and to a silencing of discussions?