Novel Anticoagulants for Non-valvular Atrial Fibrillation

Non-valvular atrial fibrillation is a major cause of strokes in patients of all ages. Warfarin has been the mainstay anticoagulant for stroke prevention for many years. Warfarin use is limited by frequent monitoring and drug interactions. New oral anticoagulants have been investigated in recent large randomised trials: direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban and apixaban). These new anticoagulants do not require regular monitoring. Dabigatran and rivaroxaban have been shown to be non-inferior, whilst apixaban has been shown to be superior to warfarin in terms of stroke and systemic embolism. There are practical issues of cost, lack of availability on the Pharmaceutical Benefits Scheme currently, and a lack of reversal agents. These new oral anticoagulants may revolutionise anticoagulation for stroke prevention in non-valvular atrial fibrillation.