The most significant complication of atrial fibrillation (AF) is thromboembolic
stroke. Furthermore, the consequences of AF-related stroke tend to be more severe
than those of other aetiologies. The need for safe, effective and convenient
anticoagulation is clear. Warfarin is the current mainstay of treatment but its
prescription and use remains sub-optimal, despite clear evidence and guidance to
support its use. Many patients taking warfarin spend a significant amount of time subtherapeutically
anticoagulated and the requirement for regular monitoring of
warfarin’s anticoagulant activity is both inconvenient and costly.
Novel oral anticoagulants promise more predictable and convenient anticoagulation.
They have potential superiority over warfarin for preventing thromboembolic stroke
and appear to be associated with fewer haemorrhagic effects. Understanding the
important background to the novel agents presents an opportunity to tailor
anticoagulant treatment to the individual. This should allow a greater proportion of
the eligible population access to effective anticoagulation. Furthermore, it should
reduce their exposure to the risk of both thromboembolic and haemorrhagic stroke
and their potentially devastating consequences
