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START anticoagulation AF — DGM MCQ

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HardPolypharmacySTART anticoagulation AFDGM

A 78-year-old man with persistent atrial fibrillation is reviewed after a transient ischaemic attack. He is not anticoagulated and has no contraindication. Renal function is acceptable. Current medicines include bisoprolol and atorvastatin. What is the most appropriate management?

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Correct answer: B — Assess stroke and bleeding risk and consider anticoagulation

Older age increases stroke risk in atrial fibrillation, so anticoagulation should be considered after assessing bleeding risk and preferences. Age alone is not a contraindication, aspirin is inferior for AF stroke prevention, rate control does not prevent embolism, and indefinite dual antiplatelets are not the standard alternative. START criteria identify important omissions as well as STOPP harms.

Reference: NICE atrial fibrillation guidance; STOPP/START criteria v3