Ján Kmec
Atrial fibrillation is the most common cardiac arrhythmia, which is associated with a five-fold risk of stroke. Assessment of thromboembolism risk against the risk of bleeding during anticoagulant treatment in practise is a critical step that is based on risk stratification scheme. The use of vitamin K antagonists was recently the most effective standard therapy in practice to prevent stroke and systemic events in patients with atrial fibrillation, however, warfarin has significant limitations, which makes treatment with vitamin K antagonists problematic for many patients and challenge for the introduction of new oral anticoagulants, which are currently targeted to the inhibition of thrombin (dabigatran etexilate) and factor Xa (rivaroxaban, epixaban, edoxaban). In patients with nonvalvular atrial fibrillation from the view of the primary efficacy outcomes (stroke or systemic embolism) all three drugs (dabigatran etexilate rivaroxaban, apixaban) proved noninferior compared to warfarin. In term of safety, all three new drugs significantly reduced the incidence of haemorrhagic stroke and intracranial haemorrhage.