The trials of novel oral anticoagulants in non-valvular atrial fibrillation and their effect on the guidelines

Although ischemic stroke is one of the most devastating complications of atrial fibrillation, it can be prevented by effective oral anticoagulation (OAC). Until recently warfarin, a vitamin K antagonist was the only effective OAC in this field. However for the well-known reasons, warfarin is a difficult drug to apply and maintain, both for the patient and physician. In order to overcome these difficulties new oral anticoagulants (NOACs) like, a direct thrombin inhibitor dabigatran and inhibitors of activated factor X rivaroxaban and apixaban are developed as alternatives to warfarin. The efficacy and safety of NOACs vs warfarin, in preventing sroke/TIA and systemic embolism in non-valvular AF is tested in randomized controlled trials (RE-LY, ROCKET AF, ARISTOTLE). Since their efficacy and safety are proven by these trials, the results of the trials had a substantial impact to the writing of new therapy guidelines. Consequently the recent focused update of AF guideline of the ESC suggests NOACs as a strong (even prior to) alternative to warfarin, with the highest level of indication and evidence.