Medical Question of the Day- 38

A 75-year-old man presents to his physician for a routine examination. He has a history of hypertension, hypercholesterolemia and osteoarthritis. He takes atenolol, simvastatin and ibuprofen as needed. His pulse is 76/min and irregular. Blood pressure is 130/74. Physical examination and imaging studies are normal except for asymptomatic atrial fibrillation.

What is the most appropriate next step in management of this patient?

A- Assurance and follow up in 3 months

B- Start aspirin

C- Start heparin

D- Start warfarin

E- Start low molecular weight heparin and warfarin


According to the most recent studies, warfarin 5 mg/day is the drug of choice for asymptomatic atrial fibrillation. Aspirin alone can be used as prophylactic if there is no AFib. Initial therapy with heparin is unnecessary because it has the same effect as warfarin alone.

The correct answer is D

Medical Question of the Day- 37

18 thoughts on “Medical Question of the Day- 38”

  1. A great question Dr Kavz. Shin necrosis is a hypothetical outcome but not seen clinically. Anyways, this option of bridging warfarin with heparin early in the treatment is not one of the choices so, I think in this case the best answer is to start warfarin. Thank you for this good question.

  2. Sir, If we start warfarin without starting heparin first don’t they have the risk of skin necrosis

  3. Thank you Dr Jannat

  4. Thank you Dr Kavz

  5. Thank you Dr Pokhrel

  6. Thank you Dr Gupta

  7. Thank you Dr Debbie

  8. Thank you Dr Touseef

  9. thank you Dr Lis

  10. Thank you Dr Jamshaid.

  11. B

  12. Given his CHADS2Vasc score of 3, he’s a candidate for anticoagulation and would start warfarin (D)

  13. B. Start aspirin

  14. B. start aspirin

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