Dabigatran, rivaroxaban and apixaban have shown to be non inferior to warfarin. However these drugs might not be indicated in a considerable group of patients, especially the elderly and those with important liver or renal impairment. The long-term safety profile is unknown and safety alerts have been published in different countries. The high cost of these agents may limit their use.
Use of the new anticoagulants remains unjustified in those patients who tolerate warfarin treatment and whose monitoring is stable. Independent clinical trials are needed to define the role of new anticoagulant agents in the treatment of non valvular AF.