New approaches to stroke prevention in atrial fibrillation.

OPINION STATEMENT: It is estimated that atrial fibrillation (AF) is responsible for almost 15% of all strokes. Several randomized clinical trials have demonstrated the superiority of adjusted-dose warfarin over aspirin for stroke prevention in AF patients, particularly in high-risk individuals. Current national guidelines from the American Heart Association/American Stroke Association recommend the use of adjusted-dose warfarin with an international normalized ratio goal of 2.0 to 3.0 for patients with ischemic stroke or transient ischemic attack with persistent or paroxysmal AF, and aspirin for those who cannot take oral anticoagulants. However, the use of warfarin may be challenging in some patients, and there is a need for alternative treatments. We describe alternative treatments for AF and provide an overview on emerging therapies.