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Atrial fibrillation anticoagulation decision — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Atrial fibrillation anticoagulation decisionUSMLE Step 3

A 69-year-old woman with persistent atrial fibrillation asks whether she needs anticoagulation. She has hypertension and diabetes. She had a gastrointestinal bleed from a gastric ulcer 5 years ago that healed after treatment. Creatinine is normal and hemoglobin is 13.2 g/dL. Which of the following is the most appropriate next step in management?

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Correct answer: E — Start oral anticoagulation after shared decision-making

Her CHA2DS2-VASc score indicates substantial stroke risk. A remote treated ulcer is not an absolute contraindication, and oral anticoagulation is superior to antiplatelet therapy for stroke prevention in atrial fibrillation.

Reference: ACC/AHA/HRS atrial fibrillation guideline