Atrial fibrillation is known to be associated with an increased risk of ischaemic stroke and systemic embolism.
After stratification using various risk calculation scores, patients were traditionally prescribed anticoagulants in the form
of Aspirin or the traditional Vitamin K Antagonists.
The use of Warfarin has proven to reduce incidents of ischaemic stroke; however its use has several limitations. The
necessity for strict anticoagulation monitoring so as to maintain the narrow therapeutic range as measured by the
international normalized ratio (INR) between 2 and 3 is one of these. In clinical practice, patients are within the
therapeutic range lesser than two-thirds of the time and furthermore, its use is associated with a significant risk of major
The advent of Novel oral Anticoagulants marks a new era in anticoagulant therapy. The use of direct thrombin inhibitors
and Factor Xa inhibitors has documented a favorable bleeding profile while being similarly or more efficacious when
compared to VKA. Early studies indicate a significant reduction in the composite of stroke or systemic embolism and
lowering of all-cause mortality. In this review we discuss the evidence for the clinical benefit and safety of the novel
anticoagulants versus warfarin among patients with atrial fibrillation and probationary guidelines towards their use.