In the United States, approximately 1 out of every 18 deaths is attributed to stroke, making it the third leading cause of death. Underutilization or inappropriate application of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) is a relatively common finding in clinical practice. Furthermore, patient and physician concern about the use of warfarin has resulted in its underutilization, particularly among elderly individuals who are at the greatest risk for cardiovascular and cerebrovascular events. The limitations of warfarin have led to the investigation and approval of more convenient anticoagulant options with more predictable pharmacokinetics and more favorable benefit-to-risk ratios, including factor IIa, factor Xa, and direct thrombin inhibitors. Despite emerging evidence of their benefit in AF-related stroke prevention, knowledge of new oral anticoagulants among healthcare providers is generally lacking. Join Drs. Bruce Lindsay and Walid Saliba for a discussion on the challenges faced during stroke risk assessment and treatment of patients with AF.