In atrial fibrillation with a history of TIA or stroke, which therapy is indicated?

In atrial fibrillation with a history of TIA or stroke, which therapy is indicated?

• A. Warfarin
• B. Aspirin
• C. Heparin
• D. Clopidogrel

Answer: (A)

When atrial fibrillation is present and there’s a history of TIA or stroke, preventing another embolic event is the priority. A prior stroke or TIA with AF marks the patient as high risk for future cardioembolic strokes, so long-term anticoagulation is indicated. Warfarin provides stronger protection against embolic events in this setting than antiplatelet therapy alone. Aspirin alone does not reduce embolic risk as effectively in AF with previous stroke, and isn’t sufficient for secondary prevention here. Heparin is used mainly for short-term inpatient anticoagulation or bridging and isn’t the preferred long-term outpatient therapy. Clopidogrel is an antiplatelet option but is less protective than anticoagulation for preventing recurrent strokes in AF. Therefore, warfarin is the best choice among these options.

When atrial fibrillation is present and there’s a history of TIA or stroke, preventing another embolic event is the priority. A prior stroke or TIA with AF marks the patient as high risk for future cardioembolic strokes, so long-term anticoagulation is indicated. Warfarin provides stronger protection against embolic events in this setting than antiplatelet therapy alone. Aspirin alone does not reduce embolic risk as effectively in AF with previous stroke, and isn’t sufficient for secondary prevention here. Heparin is used mainly for short-term inpatient anticoagulation or bridging and isn’t the preferred long-term outpatient therapy. Clopidogrel is an antiplatelet option but is less protective than anticoagulation for preventing recurrent strokes in AF. Therefore, warfarin is the best choice among these options.