Anticoagulation. Modern concepts

: An effective oral anticoagulation with vitamin K antagonists is currently a successfully used standard therapy in patients with atrial fibrillation (AF) yielding a 60-70% relative reduction in stroke risk compared with placebo, when an international normalized ratio (INR) value between 2.0 and 3.0 is maintained. However, these agents have a number of well documented shortcomings which partially result in a reduced compliance as well as an insufficient INR adjustment. A number of new drugs for oral anticoagulation including direct factor Xa inhibitors, such as rivaroxaban and direct thrombin inhibitors, such as dabigatran have shown promising results, including higher efficacy and significantly lower incidences of intracranial bleeding compared with warfarin. The new substances show similar results in secondary as well as in primary stroke prevention in patients with AF and therefore offer a number of advantages over warfarin, including a favorable bleeding profile and convenience of use. Consideration of these new anticoagulants might be a good option.