New Insights into Anticoagulation in Atrial Fibrillation

Oral anticoagulation in atrial fibrillation (AF) is important for stroke prevention. Warfarin, one of the commonly used vitamin K antagonists (VKAs), is underused in clinical practice due to its well-known limitations and complexity. Identification of patients at high risk of bleeding and weighing up the embolism and bleeding risk can help to refine anticoagulation to minimize bleeding risk. New oral anticoagulants with different mechanisms of action may replace the VKAs for a number of indications, especially AF. The oral direct thrombin and Xa inhibitors are furthest along in development. Dabigatran etexilate, a thromb in inhibitor, has recently gained a class I recommendation as an alternative option to anticoagulants for prevention of stroke in patients with AF. The percutaneous transcatheter closure of left atrial append age has been successfully developed in recent years for reducing the future stroke risk. On the basis of the recent progress, we suggest to improve warfarin therapy and balance the stroke prevention and bleeding risk. Clinicians may benefit from these new insights into anticoagulation in AF.