A 55-year-old man with paroxysmal atrial fibrillation has CHA₂DS₂-VASc score of 3 (hypertension, age 65–74, diabetes). He has HAS-BLED score of 2. Renal function is normal. Which anticoagulation is preferred per current guidelines?
- A Aspirin 75–100 mg daily
- B A direct oral anticoagulant (DOAC: apixaban, rivaroxaban or dabigatran) ✓
- C Warfarin with target INR 2–3
- D No anticoagulation; CHA₂DS₂-VASc ≥2 requires only rate control
Explanation
For non-valvular AF with CHA₂DS₂-VASc ≥2 in men (≥3 in women), oral anticoagulation is strongly recommended (Class I). DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over vitamin K antagonists (warfarin) due to superior efficacy/safety profiles demonstrated in large RCTs (RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48) and easier management without INR monitoring. Aspirin monotherapy is no longer recommended for stroke prevention in AF as it provides minimal protection with similar bleeding risk. Warfarin remains preferred only in specific cases (mechanical prosthetic valves, mitral stenosis).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.