Description

Oral anticoagulation with warfarin has been used successfully for thromboembolic prophylaxis in nonrheumatic atrial fibrillation for several decades, with the less effective antiplatelet agents as second-line for patients for whom warfarin is contraindicated or unacceptable. The importance of maximising time spent in the target range of INR 2-3 to ensure optimal stroke reduction and reduce bleeding risk has been established and the importance of delivering well organised anticoagulant monitoring services, patient education, and introducing validated benefit/risk assessment tools into clinical practice recognised. Novel anticoagulants which inhibit thrombin or factor Xa have been shown to be at least as efficacious as warfarin and to have a more favourable bleeding profile. Need for additional data on cost-effectiveness, and lack of availability as yet of direct antidotes mean that, whilst their use will increase, warfarin will continue to have a role for thromboembolic prophylaxis in atrial fibrillation for at least some time into the future.