Prepare for EMREE with practice that mirrors the official blueprint

Correct answer: C.

Her CHA2DS2-VASc score is 4 (age 65–74, female sex, hypertension, diabetes); even with the sex-neutral CHA2DS2-VA score used by ESC 2024 it is 3, well above the threshold for oral anticoagulation. In non-valvular AF without moderate-to-severe mitral stenosis or a mechanical valve, a DOAC is preferred over warfarin because it has lower rates of intracranial haemorrhage and needs no INR monitoring. Antiplatelet agents should not be used for stroke prevention in AF. Bleeding risk should be assessed (e.g. ORBIT or HAS-BLED) to modify risk factors, not to withhold anticoagulation.

• A: Antiplatelet monotherapy is not recommended for stroke prevention in AF: it is much less effective than anticoagulation and carries a similar bleeding risk.
• B: Dual antiplatelet therapy is inferior to oral anticoagulation for AF stroke prevention and causes significant bleeding.
• D: Her stroke risk is already high (CHA2DS2-VASc 4), so withholding anticoagulation is not appropriate.

High-yield: CHA2DS2-VASc ≥2 in men or ≥3 in women (CHA2DS2-VA ≥2) – offer oral anticoagulation. · DOACs are first-line in non-valvular AF; warfarin is required for mechanical valves and moderate–severe mitral stenosis. · Aspirin has no role as sole stroke prevention in AF.