According to an editorial, overall the advantages and safety/efficacy profiles of the different NOACs compared with warfarin are maintained at poor and deteriorating renal function. It notes the lack of head-to-head comparisons of the different NOACs in different patient groups and different settings, which would allow further personalised treatment. There is also a need for more information on the best choice of compound and dose in patients with good renal function. It adds that additional areas that remain poorly understood are the potential long-term benefit of NOACs compared with warfarin, and antithrombotic strategies in patients with atrial fibrillation and end-stage renal disease. It concludes that considering the majority of patients with atrial fibrillation and renal dysfunction are elderly with a higher risk of stroke and bleeding, there is an even greater need for dynamic decision support tools to help balance the risk of stroke and the risk of bleeding during ongoing anticoagulant treatment.