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

Tatjana S Potpara, Marina M Licina, Marija M Polovina

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.

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