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Atrial fibrillation in older adult — CCFP MCQ

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HardGeriatricsAtrial fibrillation in older adultCCFP

An 81-year-old woman with atrial fibrillation, hypertension and prior transient ischemic attack takes aspirin only. She has normal renal function, no history of major bleeding, and expresses concern about discontinuing aspirin due to fear of falling. What is your recommendation?

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

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Correct answer: B — Discuss initiating oral anticoagulation, explaining that stroke-prevention benefit usually outweighs fall-related bleeding risk in her case

This patient has very high stroke risk (CHA₂DS₂-VASc ≥5: age, hypertension, prior TIA). Option B is correct because it mandates discussion of anticoagulation with explicit acknowledgement of her fall concern, while conveying the evidence-based conclusion that stroke prevention benefit usually outweighs fall-related bleeding risk. Option E reverses the evidence. Option D (dual antiplatelets) is inferior to anticoagulation for AF and not guideline-recommended. Option C (age alone disqualifies) contradicts Canadian and international guidance, which emphasize stroke risk stratification over age cutoffs. Option A (CT screening) is unnecessary in the absence of acute symptoms or trauma.

Reference: Thrombosis Canada. Stroke Prevention in Atrial Fibrillation. https://thrombosiscanada.ca/clinical_guides/pdfs/STROKEPREVENTIONINATRIALFIBRIL_61.pdf (endorsed by Canadian guidelines on antithrombotic therapy); supported by Garwood & Corbett (Am J Geriatr Care. 2008) and contemporary evidence on anticoagulation in elderly patients with fall risk.