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TIA with Atrial Fibrillation — SCE Neurology MCQ

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EasyCerebrovascular DiseaseTIA with Atrial FibrillationSCE Neurology

A 72-year-old man with atrial fibrillation presents with a TIA (resolved left arm weakness lasting 20 minutes). His CHA2DS2-VASc score is 4. He is not currently on anticoagulation. What is the most appropriate long-term secondary prevention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Direct oral anticoagulant (e.g. apixaban)

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

In a patient with atrial fibrillation and a TIA, anticoagulation is the recommended secondary prevention. NICE guidelines recommend DOACs (such as apixaban, rivaroxaban, edoxaban or dabigatran) as first-line over warfarin for stroke prevention in non-valvular AF due to superior efficacy-safety profile. Antiplatelet therapy is not sufficient for cardioembolic stroke prevention. A/B: Antiplatelet monotherapy is inadequate for AF-related stroke prevention. C: Dual antiplatelet therapy is for non-cardioembolic TIA/minor stroke. E: Warfarin is second-line to DOACs per NICE AF guidelines.

Reference: NICE NG196 (2021); NICE CG180 Atrial Fibrillation (2014, updated 2021)