Future directions of stroke prevention in atrial fibrillation: the potential impact of novel anticoagulants and stroke risk stratification

Stroke prevention in atrial fibrillation is of paramount importance given its associated morbidity and mortality. The many challenges of warfarin limit its effective use in real-world clinical practice. We are entering an exciting therapeutic era as new classes of anticoagulants, including direct thrombin inhibitors, factor Xa inhibitors and novel vitamin K antagonists, are being evaluated for possible use in this patient population. If proven to be as efficacious as warfarin and safer, expanded use of these novel agents to lower risk subgroups may be justified. It is imperative that providers be aware of the many advantages and potential challenges posed by use of these novel agents in routine clinical care. An understanding of individual pharmacokinetic profiles and potential drug-drug and drug-disease interactions will translate into improved effectiveness in real-world practice.