Atrial Fibrillation in Valvular Context — EECC MCQ

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HardCardiologyAtrial Fibrillation in Valvular ContextEECC

A 62-year-old with AF and severe native aortic stenosis asks about stroke prevention. What is the preferred anticoagulant?

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Correct answer: C — Apixaban

Apixaban is the best answer. In AF requiring stroke prevention, current UK practice is to use a direct-acting oral anticoagulant (DOAC) unless contraindicated or unsuitable; apixaban is a recommended DOAC option and NICE notes it was the most clinically effective and cost-effective anticoagulant in its analysis. Severe native aortic stenosis does not by itself mandate warfarin: the classic warfarin-only situations are mechanical prosthetic valves and clinically significant/rheumatic mitral stenosis, not native aortic stenosis. Aspirin or clopidogrel should not be used as monotherapy for AF-related stroke prevention, and warfarin is reserved for patients in whom a DOAC is contraindicated, not tolerated or unsuitable.

Reference: NICE. Atrial fibrillation: diagnosis and management (NG196), 2021, recommendations 1.6.3–1.6.5 and 1.6.14. https://www.nice.org.uk/guidance/ng196/chapter/recommendations