Stroke prevention in atrial fibrillation. Old and new anticoagulants

Atrial fibrillation is the most common form of cardiac arrhythmia with an age-dependent increase in prevalence. It is common clinical practice to treat patients with atrial fibrillation and who have a high risk for thromboembolic stroke with vitamin K antagonists. However, due to the many problems with vitamin K antagonist therapy many high risk patients are either not treated at all or receive insufficient anticoagulation treatment. The new oral anticoagulants, e.g. dabigatran as a direct thrombin antagonist or rivaroxaban and apixaban as factor Xa antagonists were tested in large scale clinical trials with respect to the efficacy in stroke prevention in atrial fibrillation patients. The therapeutic superiority over warfarin could be impressively proven either with respect to the efficacy in stroke prevention and/or to the safety of therapy with a significant decrease in cerebral bleeding complications.