Atrial fibrillation stroke prevention — RACGP Fellowship MCQ

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HardChronic disease managementAtrial fibrillation stroke preventionRACGP Fellowship

A 72-year-old woman with non-valvular atrial fibrillation has hypertension and diabetes. She has no prior bleeding and normal renal function. She asks whether aspirin is enough for stroke prevention because she dislikes tablets. What is the most appropriate management?

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Correct answer: C — Recommend oral anticoagulation after discussing stroke and bleeding risk

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · E = shown as D · B = shown as E

The correct answer is A. This patient's stroke risk (age, female sex, hypertension, diabetes) necessitates anticoagulation with a DOAC (first-line) or warfarin according to current Australian guidance. Aspirin (B) is no longer supported for AF stroke prevention in patients with risk factors—it is significantly inferior to anticoagulation. Clopidogrel (C) is not recommended for AF and lacks evidence. No treatment (D) ignores her substantial stroke risk; sex alone does not determine the need for anticoagulation. Cardioversion (E) is not a prerequisite for anticoagulation and should not delay initiation. Option A correctly endorses risk discussion and shared decision-making, addressing the patient's preference while adhering to evidence-based guidelines. The discussion of bleeding risk acknowledges her stated concern about medication burden and allows for informed consent.

Reference: Australian Prescriber (Therapeutic Guidelines Limited): Atrial fibrillation: an update on management. December 2019; updated December 2025. https://australianprescriber.tg.org.au/articles/atrial-fibrillation-an-update-on-management.html and Oral anticoagulation for adults with atrial fibrillation or venous thromboembolism. October 2025. https://australianprescriber.tg.org.au/articles/oral-anticoagulation-for-adults-with-atrial-fibrillation-or-venous-thromboembolism.html