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Atrial fibrillation — RCPSC IM MCQ

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EasyCardiologyAtrial fibrillationRCPSC IM

A 74-year-old man in Toronto is admitted with palpitations and dyspnoea. ECG shows atrial fibrillation at 128 beats/min, blood pressure is 134/78 mm Hg, creatinine clearance is 52 mL/min, and transthoracic echocardiography shows normal valves. He has hypertension, diabetes, and a prior transient ischemic attack. There is no active bleeding. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Start apixaban and arrange rate control

This patient has non-valvular atrial fibrillation with a high stroke risk. A direct oral anticoagulant with rate control is appropriate because antiplatelet therapy is inadequate stroke prevention and there is no immediate indication for left atrial appendage closure.

Reference: CCS atrial fibrillation guidance; Thrombosis Canada clinical guide