Atrial fibrillation and stroke prevention: is warfarin still an option?--No

Atrial fibrillation is a common arrhythmia that increases the risk of stroke by 4.5 times. Anticoagulant/antithrombotic therapy in atrial fibrillation has been inconsistent and inappropriate. Warfarin enjoyed the monopoly of being the primary medication used to reduce the risk of thromboembolic events. Warfarin has many limitations in its use as an ideal anticoagulant. To overcome this difficulty, now there are two main alternative groups to warfarin namely, direct thrombin inhibitors (ximelagatran and dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, edoxaban, etc.). The advantages of the newer anticoagulants over the conventional warfarin are numerous. There are three landmark trials which have shown some light to the path of newer anticoagulant era, which include the following: RE-LY, ROCKET AF and ARISTOTLE. Head to head comparison of warfarin with newer anticoagulants showed the superiority of newer anticoagulants over warfarin in terms of efficacy and favorable side effect profile. After few decades of using warfarin, it‘s high time to enter into the era of newer anticoagulants and bid adieu to warfarin.