Atrial fibrillation (AF), the most common, clinically significant, cardiac 
arrhythmia affects 1% of the general population and has important hemodynamic 
and thromboembolic complications that contribute to elevated morbidity and 
mortality. AF increases the overall risk of stroke five-fold, accounting for 
approximately 15% of all strokes and is associated with particularly severe 
stroke. For the last 50 years, long-term anticoagulation with vitamin K 
antagonists has been the most effective therapy for preventing stroke and 
systemic embolism in patients with AF and other risk factors, but their use has 
a lot of limitations and drawbacks (frequent monitoring and dose adjustment, 
food and drug interactions, delayed onset of action etc). Nowadays, new oral 
anticoagulants have emerged that seem to overcome those limitations. Direct 
thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban 
have proven, in large, multicenter, randomized, phase III, clinical studies, to 
be at least as efficient as warfarin in stroke prevention in patients with AF. 
RELY and ROCKET AF trials have contributed to market approval of dabigatran and 
rivaroxaban, respectively and made them available to clinical practice. Another 
factor Xa inhibitor, edoxaban, is under evaluation in an ongoing phase III 
clinical trial and others such as AZD0837, betrixaban and darexaban are still in 
safety and tolerability phase II studies. The oral anticoagulation landscape is 
changing rapidly and these new agents seem to be very promising. However future 
post-marketing studies and registries will help clarify their efficacy and 
safety.