Any alternatives to warfarin?

We know that atrial fibrillation increases the risk of stroke fivefold and is the cause of a sixth of all strokes. But being on warfarin is a nuisance for our patients, and they often ask about other options. This editorial summarized the current position:

• Anticoagulation with warfarin remains the first line treatment
• Aspirin and combined antiplatelet therapy are not nearly as effective as warfarin
• Agents are being tested to replace warfarin (eg Ximelagratan, a direct thrombin inhibitor) but there is risk of liver toxicity
• Surgical techniques (ligation atrial appendage or catheter ablation) are not alternatives to warfarin
• Left atrial appendage occlusion by the catheter technique may prove to be a safe alternative for those who can't or won't take warfarin (the PROTECT atrial fibrillation study is ongoing)

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Source: Heart 2008;94:1113-1116