The Role of Novel Oral Anti-Coagulants in Stroke Prevention in Non-Valvualr Atrial Fibrillation

Atrial Fibrillation (AF) is the most common dysrhythmia seen in primary care. Thromboembolic stroke remains one of the most feared complications of this rhythm disturbance. Five landmark trials have demonstrated the efficacy of warfarin and aspirin in reducing this risk. Warfarin use is known to be labor intensive for patients and concerns regarding multiple drug interactions and bleed risk have limited it use in some high-risk populations. Novel oral anti-coagulants come with the promise to lower serious/fatal bleed risk and reduce drug-drug interactions. The new anti-coagulants have fewer drug interactions and do not require regular laboratory monitoring. Here we review trials demonstrating the efficacy of four new oral anticoagulants and summarize their stroke and bleed risk relative to warfarin as a gold standard.