Stroke prophylaxis in nonvalvular atrial fibrillation

Nonvalvular atrial fibrillation is the most prevalent dysrrhythmia, and carries with it an at least fivefold increased risk of ischaemic stroke. Currently, the implementation and optimization of prophylactic therapy (with warfarin or acetylsalicylic acid) is the most effective approach, at the population level, to optimize outcomes in patients with atrial fibrillation. Therefore, clinical trial evidence regarding warfarin and acetylsalicylic acid in stroke prophylaxis is highlighted. Recently, considerable data have emerged that indicate suboptimal use of warfarin in clinical practice (both in terms of the prescription and titration of therapy). Narrowing this gap between research evidence and clinical practice may be accomplished by identifying those patients who are eligible for prophylaxis, and then maintaining them at an adequate level of anticoagulation.