[Several alternatives for stroke prophylaxis in atrial fibrillation]

The anti-thromboembolic treatment of patients with atrial fibrillation is increasingly better recognized, partly because treatment is often suboptimal. Prophylactic anti-vitamin-K medication with warfarin is the most important principle in patients who have additional stroke risk indicators. At least one of the new drugs, which are currently compared with traditional treatment, seems to offer as effective stroke prophylaxis as high quality warfarin treatment, without the need of coagulation monitoring. Several alternative non-pharmacological methods are currently undergoing clinical evaluation. Long-term results of resection of left atrial appendage in association with cardiac surgery are explored in an ongoing randomized study. However, arguments have been raised against this principle, based on the physiological role of the atrial appendages in fluid regulation. Alternative methods for obliteration or occlusion of the left atrial appendage prompt further exploration.