Current Approaches to Anticoagulation for Reducing Risk of Atrial Fibrillation–Related Stroke

Stroke is a major cause of death and disability and, as such, is associated with a heavy socioeconomic burden. Atrial fibrillation (AF) is an independent risk factor for ischemic stroke, and AF-related stroke tends to be more severe and poses a higher risk of recurrence than non-AF-related stroke. Anticoagulant prophylaxis with warfarin is effective in preventing stroke in eligible patients with AF, but in real-world practice this agent, though inexpensive, is underutilized. Moreover, warfarin has notable drawbacks that result in suboptimal anticoagulation and, as a result, greater disease burden and higher costs. Newer oral antithrombotic drugs with a wide therapeutic window and no requirement for routine coagulation monitoring may be as efficacious as warfarin and, given the costs associated with managing warfarin therapy, they may also prove to be more cost effective.