1. CA is a 70-year-old female with atrial fibrillation (AF). Her past medical history includes coronary artery disease, hypertension, and depression. Her CHA2DS2-VASc score is 4. What, if any, medication should be started at this time?

2. HK is a 68-year-old female with atrial fibrillation who is preparing to start anticoagulant therapy. Her past medical history includes uncontrolled hypertension, coronary artery disease, anxiety, seasonal allergies, and peptic ulcer disease. Current medications include aspirin 81 mg daily, amlodipine 10 mg daily, duloxetine 60 mg daily, and cetirizine 10 mg daily as needed for allergies. She is considered to be at high risk for bleeding. According to the guidelines of the American College of Chest Physicians (CHEST), what anticoagulant would be most appropriate to recommend for HK?

3. Use the following patient case for questions 3 through 5: MW is a 90-year-old male with atrial fibrillation (AF) who is currently receiving warfarin. His past medical history includes diabetes mellitus, a transient ischemic attack (TIA) in 2005, and hypercholesterolemia. Which of the following patient characteristics specific to MW would likely not be represented in a randomized controlled trial?

4. MW is interested in transitioning from warfarin to a direct oral anticoagulant (DOAC) due to his difficulty maintaining a therapeutic international normalized ratio (INR). On the basis of the results of the ARISTOPHANES study, which of the following statements is correct?

5. What would be a reasonable option for anticoagulation for MW?

Evaluation Questions

6. How confident are you in your decision to treat CA above?

7. How confident are you in your decision to treat HK above?

8. How confident are you in your decision to treat MW above?

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