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Atrial Fibrillation — RACP Adult Medicine MCQ

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ModerateCardiologyAtrial FibrillationRACP Adult Medicine

A 68-year-old man with AF on warfarin presents with an INR of 1.6 on two consecutive occasions. He has poor dietary consistency and frequently misses doses. His CHA₂DS₂-VASc is 5. What is the most appropriate change?

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Correct answer: B — Apixaban 5 mg twice daily

Subtherapeutic INR on warfarin with poor compliance represents an indication to switch to a DOAC. Apixaban is preferred in this elderly patient due to its favourable bleeding profile. DOACs have more predictable pharmacokinetics and do not require routine monitoring, which addresses the compliance issue.

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