Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1–2% of general population. Over 6 million Europeans suffer from this arrhythmia and its prevalence is estimated to at least double in the next 50 years as the population ages. AF confers a 5-fold risk of stroke and one in five of all strokes is attributed to this arrhythmia. Management of AF patients is aimed at reducing symptoms and at preventing severe complications associated with AF. Prevention of AF-related complications relies on antithrombotic therapy, control of ventricular rate, and adequate therapy of concomitant cardiac diseases. Antithrombotic therapy to prevent thrombo-embolism is recommended for all patients with AF, except in those at low risk (lone AF, aged <65 years, or with contraindications). Numerous clinical trials have provided an extensive evidence base for the use of antithrombotic therapy in AF. Results of these trials support use of vitamine K antagonists (warfarin). Moreover, several new anticoagulant drugs—broadly in two classes, the oral direct thrombin inhibitors (e.g. dabigatran etexilate) and the oral factor Xa inhibitors (e.g. rivaroxaban, apixaban) were developed for stroke prevention in AF. Finally, randomized, double-blind clinical trial ROCKET AF confirmed in patients with AF that rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group. In conclusion, rivaroxaban therapy was more safe and at least of the same efficacy like therapy with warfarin.