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Atrial fibrillation requiring anticoagulation assessment — MCCQE Part 1 MCQ

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HardPalpitationsAtrial fibrillation requiring anticoagulation assessmentMCCQE Part 1

A 69-year-old woman with hypertension presents with palpitations for 18 hours. ECG shows atrial fibrillation at 122/min, blood pressure is 124/76 mmHg, and she has no chest pain or heart failure. Her symptoms improve after rate control. What is the most appropriate next step in management?

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Correct answer: B — Start oral anticoagulation after assessing bleeding risk

Stroke prevention is central in atrial fibrillation; age over 65 and hypertension confer sufficient risk for oral anticoagulation unless bleeding risk is prohibitive. Acetylsalicylic acid is not adequate stroke prevention for AF. Cardioversion planning still requires attention to anticoagulation and thromboembolic risk.

Reference: CCS/CHRS Atrial Fibrillation Guidelines; Thrombosis Canada