A review of novel oral anticoagulants in the prevention of stroke for non-valvular atrial fibrillation

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke due to intra-cardiac thrombus formation. For decades the mainstay of oral anticoagulation therapy, to reduce stroke risk in AF, has been warfarin; but over the last 5 years there have been advances in pharmacological therapies with the development of novel oral anticoagulants (NOACs). In 2012, the National Institute for Health and Care Excellence (NICE) approved the use of the following NOACs; dabigatran, rivaroxaban and apixaban in the prevention of stroke in AF. More recently, it has also approved the use of edoxaban as another alternative anticoagulant to warfarin. The use of NOACs for stroke prevention in AF is now becoming commonplace and therefore it is important to not only recognise these agents but understand their indications, contra-indications, complications and limitations. This article reviews the clinical evidence that supports the use of NOACs as well as discussing these advantages and disadvantages.