Atrial fibrillation (AF) increases the risk of stroke, making the choice of antithrombotic treatment an important clinical decision. In this DHA GP clinical challenge, a 72-year-old woman with hypertension, type 2 diabetes and a previous transient ischaemic attack presents a clear stroke-prevention dilemma. Which option offers the most appropriate protection? Work through the clinical clues, understand why oral anticoagulation is preferred, and learn the common exam trap involving aspirin and stroke prevention in AF.
Clinical Case
A 72-year-old woman with non-valvular atrial fibrillation has hypertension, type 2 diabetes and a previous transient ischaemic attack. Renal function is normal and she has no history of bleeding. Which option is most appropriate for stroke prevention? A. Aspirin 75 mg daily
B. A direct oral anticoagulant (e.g. apixaban)
C. No antithrombotic therapy
D. Aspirin plus clopidogrel
E. Warfarin, target INR 3.0–4.0
Correct Answer B. A direct oral anticoagulant (e.g. apixaban)
Her CHA2DS2-VASc score is 6 (age 65–74 =1, female =1, hypertension =1, diabetes =1, prior TIA =2), so she needs oral anticoagulation, and a DOAC is preferred over warfarin in non-valvular AF — comparable efficacy, less monitoring, lower intracranial bleeding risk.
Why the other options are wrong
A. Aspirin is not recommended for stroke prevention in AF.
C. No therapy is inappropriate at high stroke risk.
D. Dual antiplatelet therapy is inferior and adds bleeding risk.
E. Warfarin is an option, but the AF target INR is 2.0–3.0, not 3.0–4.0, and DOACs are now first-line.
Exam Trap
Offering aspirin for AF stroke prevention — obsolete. The choice is anticoagulation, a DOAC first.
Reference NICE NG196 — Atrial fibrillation: diagnosis and management (2021).
Start your DHA preparation the smarter way.
Explore our free DHA resources and start preparing with a more focused approach
Test your clinical reasoning with a DHA-style mini exam.
Free sample questions with explanations, the exam blueprint and high-yield notes.
No credit card required. Start whenever you're ready.
Why doctors choose Qualifyra?
A smarter way to prepare for DHA
Detailed explanations & references
Distractor reasoning & exam trap
Topic-wise performance analysis
Guideline-built questions
Faculty review
Send me the Starter Pack
A focused set of free DHA GP resources — sample questions with full explanations, the DHA GP exam blueprint, and high-yield revision notes — straight to your inbox.
Thank you!
No spam — just useful DHA prep. Unsubscribe anytime.
No credit card required. Start whenever you're ready.
How ready are you for the DHA GP exam?
Take the Free DHA GP Mini-Exam with 28 DHA-style questions, realistic clinical scenarios and detailed explanations.
Created with
Login or sign up to start learningLogin to start learning
