Abstract
Anticoagulant therapy plays an important role in primary and secondary prevention of brain embolism in patients with non-valvular atrial fibrillation and other sources of cardioembolic strokes. The most commonly used anticoagulant in these indications is warfarin.
Warfarin significantly reduces the risk of stroke and death, but increases that of bleeding. Life-threatening intracerebral haemorrhage is the most serious complication of anticoagulant therapy, with a mortality, that can exceed 50 %.
New oral direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban) present promising alternatives to warfarin. Dabigatran etexilate is already approved for prevention of ischaemic stroke in patients with atrial fibrillation at risk of stroke.
Dabigatran is more effective than warfarin, and has demonstrated a good safety profile.