Novel oral anticoagulants for stroke prevention in atrial fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting 1-2% of the general population. The prevalence of AF increases with age and with a growing aging population it is expected to double over the next five decades. AF poses a significant risk factor for stroke, currently conferring a five-fold risk, with one in five strokes attributed to this common arrhythmia. Furthermore, strokes relating to AF are likely to be more debilitating than non-AF related strokes. This causes increased morbidity and mortality and leads to increased physical and psychological distress for the affected patients and their families; as well as additional cost to the community. Preventing stroke in patients with AF is therefore of paramount importance. Over the last few decades the benefit of anticoagulation in patients with AF has been increasingly understood and gained popularity. This is usually achieved with oral vitamin K antagonists, most commonly warfarin. However, novel oral anticoagulants (NOACs) have advantages over warfarin and might provide an alternative to this therapy. This chapter discusses the NOACs dabigatran, rivaroxaban and apixaban and their evidencebased role in anticoagulation for patients with AF.