Atrial fibrillation (AF) is the most common type of cardiac rhythm abnormality in adults, affecting 1 to 1.5% of the general population in the Western world and is the major risk factor for
stroke with a fivefold risk compared with the general population. Pharmacological and nonpharmacological strategies are available for controlling recurrent or permanent AF as well as for prevention of AF. Prevention of recurrent AF is one of the best protections against AF-related
stroke and reduces the prevalence of
stroke by almost 25%. Antiplatelet compounds are indicated for CHAD scores 0-1 and reduce the risk of
stroke from AF by 20 to 25%. For CHAD scores >1 oral anticoagulation with
vitamin K antagonists is indicated and reduces the risk of
stroke by 62%. Since inhibitors of
coagulation factors Xa, VII , or II a have either not been clinically tested for their efficacy for prevention of
stroke from AF, did not show a comparable effect to well-established drugs, or had excess side effects (
idraparinux,
ximelagatran), and since mechanical devices are highly questionable concerning their long-term effect, there is currently no alternative to oral anticoagulation with
vitamin K antagonists as primary or secondary
stroke prevention in high-risk AF patients.