A 58-year-old man is found to have atrial fibrillation. He has hypertension, diabetes, and a prior TIA. What is his CHA₂DS₂-VASc score and the recommended management?
- A Score 4; start oral anticoagulation with a DOAC ✓
- B Score 2; aspirin monotherapy is sufficient
- C Score 3; rate control alone without anticoagulation
- D Score 5; rhythm control with amiodarone preferred over anticoagulation
Correct answer: A. Score 4; start oral anticoagulation with a DOAC
Explanation
CHA₂DS₂-VASc scoring: hypertension (1) + diabetes (1) + prior TIA/stroke (2) = 4. A score ≥ 2 in males (or ≥ 3 in females) mandates oral anticoagulation. DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for non-valvular AF per ESC 2020/AHA 2023 AF guidelines due to superior efficacy and safety profiles (RE-LY, ROCKET-AF, ARISTOTLE trials). Aspirin has no role in AF stroke prophylaxis. Rate versus rhythm control does not supersede the need for anticoagulation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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