A 60-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4 (prior stroke, hypertension, age 60–74, diabetes). He has no contraindications. Current guidelines recommend:
- A Dual antiplatelet therapy with aspirin plus clopidogrel
- B Aspirin alone is adequate for low-risk AF
- C Long-term oral anticoagulation with a NOAC (apixaban or rivaroxaban preferred over warfarin) ✓
- D Anticoagulation should be withheld until a repeat echocardiogram confirms LV function
Correct answer: C. Long-term oral anticoagulation with a NOAC (apixaban or rivaroxaban preferred over warfarin)
Explanation
A CHA2DS2-VASc score ≥2 in men (or ≥3 in women) mandates long-term oral anticoagulation for stroke prevention in non-valvular AF. NOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin due to superior efficacy-safety profiles demonstrated in ARISTOTLE, ROCKET-AF, RE-LY, and ENGAGE AF-TIMI 48 trials. Antiplatelet therapy is not an adequate substitute for anticoagulation in AF stroke prevention.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.