The US FDA has approved dabigatran (Pradaxa) for the prevention of stroke and systemic embolism in patients with atrial fibrillation. The drug will be available in two doses: 150 mg twice daily and, for a small subset with severe renal impairment, 75 mg twice daily. At last there is an oral anticoagulant that is at least as safe and effective as warfarin but is more consistent in its effects and does not require cumbersome anticoagulation monitoring or careful attention to diet.