Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia which increases the risk of ischemic stroke by 4- to 5-fold. AF-related stroke has a worse prognosis and higher recurrence rate compared to non-AF related stroke. Therefore, stroke prevention is the cornerstone for the management of AF.
　　Treatments with oral anticoagulants (OAC) with vitamin K antagonists (VKAs), such as warfarin, could effectively reduce the risk of stroke by 64% compared to placebo. In recent years, several non-VKA oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, apixaban and edoxaban, were demonstrated to be at least as effective as warfarin in stroke prevention, and were safer in the risk of intra-cranial hemorrhage. The recent meta-analysis has demonstrated that Asians may get more benefits from the use of NOACs compared to warfarin than non-Asians. The 2016 AF guidelines of European Society of Cardiology recommend a NOAC in preference to a VKA when oral anticoagulation is initiated in a patient with AF who is eligible for a NOAC.
　　However, there are still some contraindications for the use of NOACs, including the presence of mechanical valves, significant mitral stenosis and advanced renal dysfunctions. Therefore, the choice of warfarin or NOACs for stroke prevention should be individualized for each patient.