OBJECTIVES:  To evaluate treatment patterns in patients with non-valvular atrial fibrillation (NVAF) in Italy pre and post Xabans/direct thrombin inhibitors (DTIs) approval, and to assess patients’ characteristics (age, Charlson index) and risks (CHADS-VASc, HAS-BLED). METHODS: A retrospective analysis, using administrative databases from 3 Local Health Units (LHUs) in Italy, was conducted. Patients with a discharge diagnosis of NVAF (ICD-9-CM) in 2010 and 2014 were included. The inclusion date was used as the index date, patients enrolled in 2010 were considered as the pre-Xabans/DTIs population, while patients enrolled in 2014 as the post-Xabans/DTIs population. Antithrombotic therapies post discharge among patients with NVAF was assessed and compared to ESC Guidelines recommendations which advice to use anticoagulants among patients with NVAF and a CHADS-VASc score of 1 or more. RESULTS: DS-VASc score of 1 or more were enrolled.Pre-Xaban/DTIs, 44% of patients were treated with a VKA, 46% were treated with an antiplatelet and 10% received no antithrombotic treatment, compared to 36%, 43% and 8% in the post-Xaban/DTIs period. In addition to this, in the post Xaban/DTIs period, 13% of the enrolled patients received a Xaban/DTI. Antiplatelet agents were commonly used in older patients despite guidelines recommendations (average age of antiplatelet agent user 75.2 years old and 77.2 years old in 2010 and 2014 respectively). CONCLUSIONS: Despite a slight improvement in adherence to guidelines recommendations potentially attributable to the launch of Xaban/DTIs and related communication campaigns, an unmet medical need remains among Italian patients with NVAF according to ESC Guidelines.