Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Changing Landscape

Atrial fibrillation is the most common sustained cardiac arrhythmia. Thromboembolic events related to atrial fibrillation result in significant morbidity, mortality and increases in the cost of healthcare. For decades, vitamin Kantagonists have been the mainstay of long-term oral thromboprophylactic anticoagulant therapy. Although these drugs are effective, the narrow therapeutic range, the numerous drug-drug and or drug-food interactions constitute limitations, which have driven the development of new anticoagulant agents. The emerging oral anticoagulant agents are target selective, have more predictable pharmacokinetic and pharmacodynamic parameters and do not require routine monitoring. Recent trials have demonstrated the safety and efficacy of the new direct thrombin inhibitor dabigatran as well as for the selective factor Xa inhibitors rivaroxaban and apixaban. This article reviews the current literature and highlights the challenges associated with the use of new oral anticoagulants for atrial fibrillation in daily practice.