Stroke prevention in atrial fibrillation--current standard of care and significant unmet medical need.

The estimated prevalence of atrial fibrillation (AF) in Europe is 4.5 million and in America is 5.1 million. Arterial thromboembolism, stroke, and heart failure are the some of the most serious complications of AF. There is a fivefold increase in the risk of stroke and the risk of death doubles among patients with AF when compared with the control population. AF-related strokes are more disabling and fatal. The ESC 2010 guidelines and the 2011 ACCF/AHA/HRS update on the management of patients with AF recommend use of adjusted dose warfarin for all patients with a CHA2DS2-VASc score > or = 1. Though an effective drug, warfarin remains underused due to the several limitations associated with its use. It is limited by a slow onset and offset of action, unpredictable pharmacokinetics, several drug-drug and drug-food interactions and need for regular INR monitoring and dosage adjustments. Newer anticoagulants developed as an alternative to warfarin have better pharmacological and safety profiles and promises effective stroke prevention in AF.