Repeated USMLE Questions Step 2 CK- 424

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

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