skip to main content

Starting anticoagulation after AF-related stroke — SCE Geriatric Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardStroke careStarting anticoagulation after AF-related strokeSCE Geriatric Medicine

An 86-year-old woman with atrial fibrillation and severe frailty presents with an ischaemic stroke affecting the right MCA territory. She was taking no anticoagulant because of previous epistaxis. CT at 24 hours shows a moderate infarct without haemorrhagic transformation; swallowing is safe and BP is 138/76 mmHg. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Plan initiation of anticoagulation after specialist assessment of infarct size, bleeding risk and timing

After AF-related ischaemic stroke, anticoagulation is usually indicated but timing depends on stroke severity, infarct size and haemorrhagic transformation risk. Specialist stroke assessment should balance recurrent embolism against intracranial bleeding. Frailty alone does not exclude anticoagulation, and aspirin is inferior for AF stroke prevention. The pearl is that timing is individualised rather than simply immediate or indefinite deferral.

Reference: National Clinical Guideline for Stroke 2023; NICE NG196