New anticoagulants in patients with non-valvular atrial fibrillation

Atrial fibrillation is the most frequent sustained cardiac arrhythmia and a common reason for therapeutic anticoagulation in patients exhibiting additional risk factors for thromboembolic events. For several decades, the mainstay therapy have been oral vitamin K antagonists despite their shortcomings in daily practice including difficult dosage due to food and drug interactions and the need for regular monitoring of the intensity of anticoagulation. Newly developed anticoagulants include oral, direct thrombin antagonists (dabigatran) and factor Xa antagonists (rivar-oxaban, apixaban). Apart from a lesser potential for interactions and thereby greater ease of use, these substances have shown a favorable risk/benefit profile in large randomized clinical trials, preventing stroke and other systemic thromboembolic events at least as effective as warfarin while reducing hemorrhagic stroke and intracranial bleeding compared to warfarin. These findings were also consistent in subgroup analyses of high-risk patients in secondary stroke prophylaxis.