Stroke prophylaxis in patients with non-valvular atrial fibrillation is becoming an increasingly dynamic field. The new guidelines from the European Society of Cardiology (ESC) recommend a stroke- and bleeding risk-assessment in patients with non-valvular atrial fibrillation using the CHA2DS2VASc and the HAS-BLED scores, respectively. Furthermore, new drugs for stroke prophylaxis such as dabigatran, rivaroxaban and apixaban are undergoing approval in Europe and will undoubtedly challenge the well-established vitamin K antagonists. Hence, stroke prophylaxis is likely to become a much more individualized treatment in the future. This review should help to critically weigh the pros and the cons of the new therapeutic options.