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Atrial Fibrillation — RACP Adult Medicine MCQ

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ModerateCardiologyAtrial FibrillationRACP Adult Medicine

A 78-year-old man presents with palpitations and an irregularly irregular pulse at 142 bpm. ECG shows absent P waves with fibrillatory baseline. He has no prior history of AF. His CHA₂DS₂-VASc score is 4. What is the most appropriate anticoagulant?

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Correct answer: B — Apixaban 5 mg twice daily

For new-onset atrial fibrillation with CHA₂DS₂-VASc ≥2 in men (≥3 in women), anticoagulation is recommended. DOACs are preferred over warfarin in non-valvular AF. Apixaban has the most favourable safety profile in elderly patients. Given his age (≥80), dose reduction to 2.5 mg BD should be considered if additional criteria are met (weight ≤60 kg or creatinine ≥133 μmol/L).

Reference: NHFA/CSANZ – 2018 – AF Guidelines; eTG Cardiovascular 2024