Atrial Fibrillation — RACP Adult Medicine MCQ

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EasyCardiologyAtrial FibrillationRACP Adult Medicine

A 58-year-old man with atrial fibrillation and a mechanical mitral valve prosthesis requires anticoagulation. Which anticoagulant is most appropriate?

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Correct answer: C — Warfarin

DOACs are contraindicated in patients with mechanical heart valves. Warfarin remains the only recommended anticoagulant for mechanical valve prostheses, with an INR target of 2.5–3.5 for mitral mechanical valves. The 2025 Australian ACS guideline also specifies warfarin over DOACs for mechanical valves and rheumatic mitral stenosis.

Reference: NHF/CSANZ – 2018 – Australian AF Guidelines; eTG – 2025 – Cardiovascular