A 68-year-old woman with hypertension and paroxysmal AF has a CHA₂DS₂-VASc score of 4. She has a HAS-BLED score of 2. According to ESC 2020 AF guidelines, the MOST appropriate antithrombotic strategy is:
- A Aspirin 100 mg daily as antiplatelet therapy for stroke prevention
- B Withhold anticoagulation due to moderate bleeding risk (HAS-BLED 2)
- C Oral anticoagulation with NOAC (e.g., apixaban or rivaroxaban) is recommended ✓
- D Warfarin only; NOACs are not approved for AF stroke prevention
Correct answer: C. Oral anticoagulation with NOAC (e.g., apixaban or rivaroxaban) is recommended
Explanation
ESC 2020 AF guidelines recommend NOAC (non-vitamin K antagonist oral anticoagulant) as first-line over warfarin for stroke prevention in non-valvular AF when oral anticoagulation is indicated. A CHA₂DS₂-VASc score ≥2 in women (or ≥3 depending on region) clearly mandates anticoagulation. A HAS-BLED score of 2 is moderate risk and does not contraindicate anticoagulation — rather, it prompts identification and correction of modifiable bleeding risk factors. Aspirin alone is explicitly not recommended for AF stroke prevention per ESC 2020.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.