Alternatives to warfarin for thromboembolism prophylaxis in nonrheumatic atrial fibrillation.

Decision-making regarding thromboembolism prophylaxis in atrial fibrillation remains a major clinical challenge. While evidence of the beneficial effect of anticoagulation for patients participating in clinical trials is well established, only half of eligible individuals in the general population are currently treated with warfarin. Using an evidence-based approach, this review covers major therapeutic approaches in practice today and many of those expected to be released in the near future. Pharmacologic agents evaluated include warfarin, aspirin, other antiplatelets agents, direct thrombin inhibitors and antiarrhythmic drugs. Nonpharmacologic treatments reviewed include surgical and catheter ablation, pacing, left atrial appendage ligation and occlusion methods, and atrial defibrillators.