Although phase III clinical trials provide the highest-quality level of evidence it is important to have results from observational real-life cohort studies, as patients in daily clinical practice may substantially differ from those included in RCTs, in terms of comorbidities as very elderly or patients with cancer or advanced chronic and liver disease are usually excluded or under-represented. Furthermore, patients included in RCT are usually strictly monitored and length of follow-up is usually
Again , a confirmation that the external validity of RCTs is limited and real life follow up data a necessary. All DOACs have been compared to VKA , but not against each other .
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