Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a major 
risk factor for ischemic stroke. Antithrombotic therapy using aspirin or vitamin 
K antagonists (VKA) is currently prescribed for prevention for ischemic stroke 
in patients with AF. A narrow therapeutic range and the need of regular 
monitoring of its anticoagulatory effect impair effectiveness and safety of VKA, 
causing a need for alternative anticoagulant drugs. Recently developed 
anticoagulants include direct thrombin antagonists such as dabigatran or factor 
Xa inhibitors such as rivaroxaban, apixaban, betrixaban, and edoxaban. 
Currently, data from a phase III clinical trial are available for dabigatran 
only, which show the direct thrombin antagonist to be at least noninferior in 
efficacy to VKA for the prevention of stroke and systemic embolism in patients 
with AF. This review focuses on current advances in the development of directly 
acting oral anticoagulant drugs and their potential to replace the VKA class of 
drugs in patients with AF.