Atrial fibrillation – anticoagulation threshold — UKMLA MCQ

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ModerateCardiologyAtrial fibrillation – anticoagulation thresholdUKMLA MRCGP AKT PARA MRCP Part 1 PSA

A 56-year-old man is reviewed in general practice after atrial fibrillation is confirmed. His only CHA2DS2-VASc risk factor is treated hypertension, giving a score of 1. He has no contraindication to anticoagulation, and his bleeding risk has been assessed. Which is the single most appropriate approach to long-term stroke prevention?

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Correct answer: C — Consider a direct-acting oral anticoagulant

NICE recommends considering anticoagulation with a direct-acting oral anticoagulant (DOAC) in men with atrial fibrillation and a CHA2DS2-VASc score of 1, taking bleeding risk and the person’s preferences into account. This is an intermediate-risk group: anticoagulation is considered rather than automatically offered. No treatment is therefore not the default without an individualised discussion. Aspirin monotherapy is not recommended solely for stroke prevention in atrial fibrillation, and dual antiplatelet therapy is not an alternative to anticoagulation. A vitamin K antagonist such as warfarin is generally reserved for situations in which DOACs are contraindicated, not tolerated or otherwise unsuitable.

Reference: National Institute for Health and Care Excellence. NG196: Atrial fibrillation: diagnosis and management, section 1.6, recommendations 1.6.1–1.6.5 and 1.6.14. 2021. https://www.nice.org.uk/guidance/ng196/chapter/Recommendations