Given the increasing prevalence of atrial fibrillation, the need for safe and 
effective stroke prophylaxis will continue to rise. Warfarin has been around for 
many years and has proven efficacy in preventing stroke, but it has major 
limitations due to its variable dosing, food and drug interactions, and 
requirement for regular monitoring. Newer agents which include dabigatran, 
rivaroxaban, and apixaban have recently or will soon be available and may 
provide an improved efficacy in stroke prevention, an improved safety profile, 
and improved user-friendliness. Dabigatran was the first of the agents to be 
widely available, and in the RE-LY study, dabigatran (150 mg dose) showed 
superiority to warfarin in preventing ischemic stroke and a significant 
reduction in intracranial bleeding. Rivaroxaban was studied in the ROCKETAF 
trial, and with once daily dosing, it showed noninferiority to warfarin in 
preventing stroke with a significant reduction in intracranial bleeding. The 
ARISTOTLE trial showed apixaban was superior to warfarin for stroke prevention, 
significantly reduced all major bleeding, and resulted in a significant 
reduction in all-cause mortality. While all three trials have important 
limitations, they were very large randomized trials with more than 14,000 
patients each and show a clear overall net clinical benefit when compared with 
warfarin. Key features of the drugs as well as an individual's preferences and 
stability on warfarin will help guide the ultimate drug choice for any given 
patient, but these newer anticoagulant agents are likely to usher in a new era 
in stroke prevention in atrial fibrillation.