Practical approaches to the treatment of atrial fibrillation: focus on stroke prevention using oral anticoagulant drugs

SUMMARY Atrial fibrillation (AF) confers a significant risk of ischemic stroke, and oral anticoagulation is the most effective therapy for thromboprophylaxis in AF. Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants. However, numerous disadvantages of VKAs and anticipated bleeding risk with treatment have resulted in their substantial underutilization in clinical practice. Recently, the two other classes of oral anticoagulants – direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., rivaroxaban and apixaban) – have emerged as a viable alternative to VKAs for stroke prevention in AF. In addition, efforts have been made to facilitate the optimal prevention of AF-related stroke by improvement of both stroke and bleeding risk assessment. In this review, we summarize the recent advances and discuss the contemporary practical aspects of stroke prevention in patients with nonvalvular AF.