Stroke Prevention in Atrial Fibrillation: Managing the Risks in Light of New Oral Anticoagulants

Abstract

Anticoagulation in patients with atrial fibrillation is essential to reduce morbidity and mortality associated with stroke, but at the same time the risk of bleeding needs to be carefully considered. There have been many recent developments in anticoagulation to improve medical management of these patients. CHA₂DS₂-VASc and HAS-BLED are two new algorithms that clinicians may use prior to initiating anticoagulation to estimate the risk of stroke and bleeding in patients with atrial fibrillation. In addition, new classes of oral anticoagulants such as direct thrombin inhibitors and selective Factor Xa inhibitors have emerged and consist of agents that aim to address many of the practical management challenges of warfarin. In this review of the literature, results of the clinical trials involving these new agents will be discussed and compared, with a focus on the balance between efficacy and safety.