The topic of anticoagulant prescription in patients with nonvalvular atrial fibrillation, for the primary and secondary prevention of stroke, provides a forum for discussion of current challenges in anticoagulation management and ways in which the introduction of ximelagatran will provide an opportunity to overcome many of them. Anticoagulation with warfarin has been shown to reduce stroke rates by 68%, providing significant net monetary savings. However, physician fear of hemorrhagic side effects, the need for regular INR monitoring, food and drug interactions, and patient noncompliance have all played a part in either suboptimal utilization or complete avoidance of anticoagulant therapy, even in patients at high risk for stroke. Ximelagatran, a new oral direct thrombin inhibitor, circumvents most of these problems and provides a more physician- and patient-friendly method of stroke prophylaxis. With the utilization of this new anticoagulation method, the incidence of stroke in high risk groups, and the corresponding quality-of-life and economic impact, can potentially be greatly reduced.