DOAC for AF — RACP Adult Medicine MCQ

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EasyCardiologyDOAC for AFRACP Adult Medicine

A 72-year-old man with paroxysmal AF, hypertension, diabetes, and prior TIA (CHA₂DS₂-VASc 5) has normal renal function (eGFR 85). He has no contraindications to anticoagulation. What is the most appropriate anticoagulant?

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Correct answer: B — Apixaban 5 mg BD

CHA₂DS₂-VASc ≥2 in males (≥3 in females) warrants oral anticoagulation. DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin (superior safety profile, no monitoring). Apixaban has the best safety data in elderly patients (ARISTOTLE trial: lower major bleeding than warfarin). Aspirin alone is NOT recommended for stroke prevention in AF (inferior to anticoagulation with similar bleeding risk — AVERROES trial).

Reference: CSANZ – 2024 – AF; ESC 2024 AF Guidelines