Monotherapy with the non-vitamin K antagonist oral anticoagulant rivaroxaban is noninferior for efficacy and superior for safety compared with combination therapy with rivaroxaban plus a single antiplatelet agent in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD), according to results from the AFIRE trial presented at the ESC Congress 2019. The trial was stopped early owing to increased mortality in the combination-therapy group. The trial was conducted in Japan and included 2,236 patients with AF who had undergone revascularization >1 year earlier or who had confirmed CAD not requiring revascularization. The rate of the primary efficacy end point (a composite of cardiovascular events and all-cause death) was similar in the rivaroxaban and combination-therapy groups (HR 0.72, 95% CI 0.55–0.95, P < 0.001 for noninferiority). Major bleeding event rates were lower with rivaroxaban monotherapy than with combination therapy (HR 0.59, 95% CI 0.39–0.89, P = 0.01 for superiority).