Question

A 76-year-old woman with hypertension and heart failure with preserved ejection fraction is found to have non-valvular atrial fibrillation on ECG during a routine visit. She has no prior stroke or TIA. Her CHA₂DS₂-VASc score is 4 (age, sex, hypertension, heart failure). What is the most appropriate management regarding thromboembolism prevention?

Accepted Answer

Initiate oral anticoagulation with a direct oral anticoagulant at an appropriate dose

Answer

No anticoagulation is required because she is female and asymptomatic

Answer

Start aspirin 100 mg daily as sole antithrombotic therapy

Answer

Initiate oral anticoagulation only if she develops symptoms of palpitations

Answer

Defer decision until a transoesophageal echocardiogram excludes atrial thrombus

Practice question