Question

A 78-year-old woman with hypertension and type 2 diabetes presents for review. She has non-valvular atrial fibrillation with a CHA2DS2-VA score of 4. She is independently mobile, has no history of falls and normal renal and liver function. She is not currently on anticoagulation. What is the most appropriate strategy regarding stroke prevention?

Accepted Answer

Start a therapeutic dose direct oral anticoagulant unless contraindicated

Answer

No anticoagulation is required because she is over 75 and at high bleeding risk

Answer

Start aspirin 100 mg daily for stroke prophylaxis

Answer

Start dual antiplatelet therapy with aspirin and clopidogrel

Answer

Offer low-dose warfarin (target INR 1.5-2.0) to reduce bleeding risk

Practice question