Stroke is a major complication of atrial fibrillation, prevention of which is a major challenge in the treatment of this common arrhythmia. The recently updated European Society of Cardiology guidelines emphasise a risk factor based strategy for decisions on antithrombotic drugs. Oral anticoagulation is the gold standard, although several challenges remain in its implementation. New alternative agents to warfarin are being developed and once available, they could be important therapeutic advances in the care of patients with atrial fibrillation.