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Atrial fibrillation anticoagulation — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareAtrial fibrillation anticoagulationUSMLE Step 3

A 72-year-old woman has persistent nonvalvular atrial fibrillation found at follow-up. She has hypertension and type 2 diabetes. She has no bleeding history, mechanical valve, or moderate-to-severe mitral stenosis. Creatinine clearance is normal. Which of the following is the most appropriate next step in management?

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Correct answer: E — Start a direct oral anticoagulant

Her CHA2DS2-VASc score indicates substantial stroke risk; a direct oral anticoagulant is preferred for eligible patients with nonvalvular atrial fibrillation.

Reference: ACC/AHA/HRS Atrial Fibrillation Guideline