Current strategies of anticoagulation therapy for patients with non-valvular atrial fibrillation

Cardioembolic stroke accounts for 20–30% of acute brain infarctions in Japan. This condition is often severe and has poor outcomes. Non-valvular atrial fibrillation (NVAF) is the most common cardiac source of emboli in cardioembolic stroke. Anticoagulants are recommended for preventing stroke in patients with NVAF, and these patients were usually treated with warfarin. However, the use of warfarin has many limitations. Approximately half of the patients with NVAF, who show indications for warfarin treatment, are treated with warfarin. Bleeding complications, including intracranial hemorrhages, are common during warfarin treatment; this is a huge concern of warfarin treatment. Warfarin-associated intracranial hemorrhage is often severe and devastating. Several novel anticoagulants that can overcome the limitations of warfarin have been introduced in the market or are under development. In this review, we discuss the pharmacological properties of novel anticoagulants and current strategies of anticoagulation therapy for preventing stroke in patients with NVAF.