For more than 60 years, vitamin K antagonists have been the only available oral 
anticoagulants for the prevention of stroke and systemic embolism in atrial 
fibrillation (AF). Several new molecules, with a favorable pharmacokinetic 
profile and avoiding routine monitoring, have been recently developed, opening a 
new era in anticoagulation. The oral direct thrombin inhibitor, dabigatran, and 
the oral activated factor X inhibitors, rivaroxaban and apixaban, are the novel 
oral anticoagulants with data from large randomized clinical trials showing that 
these drugs are noninferior to warfarin in the prevention of stroke and 
thromboembolic complications of AF, with the advantage of less hemorrhagic 
stroke and intracranial bleeding. While these trial data are extremely 
encouraging, several practical issues (e.g., lack of specific antidote, safety 
of long-term treatment or cost-effectiveness in "real-life" clinical practice) 
still need to be elucidated.