Until recently, warfarin has been the gold standard for reducing stroke risk and mortality in patients with atrial

fibrillation (AF). The key goals of antithrombotic treatment are the primary and secondary prevention of ischemic

stroke and systemic embolism while minimizing the risk of major bleeds. While highly effective, warfarin has several limitations that have led to well-documented underutilization and suboptimal care by both physicians and patients. Recently, two classes of novel oral anticoagulants (NOACs) have emerged that may overcome some of the clinical challenges associated with warfarin use: the oral direct thrombin inhibitors (dabigatran) and the oral direct factor Xa inhibitors (rivaroxaban, apixaban). Most recently, the US Food and Drug Administration approved edoxaban in January 2015 and a European Medicines Agency approval application was filed for edoxaban in 2014) [1]. As clinical experience and outcomes research continue to accumulate for NOACs, practical approaches for their clinical use and optimizing patient outcomes continue to evolve.