Cardiology: anticoagulation in valvular AF: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: anticoagulation in valvular AF

Sample item

A patient with moderate-to-severe rheumatic mitral stenosis develops atrial fibrillation. Which anticoagulant is recommended?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Warfarin with target INR 2 to 3

DOACs were inferior to warfarin in patients with rheumatic mitral stenosis (INVICTUS) and in mechanical valves. Vitamin K antagonists remain the standard in valvular AF of this type. Aspirin alone is insufficient for stroke prevention.

Option by option

  • A. Dabigatran

    Dabigatran is not recommended in this setting.

  • B. Rivaroxaban

    Rivaroxaban did worse than VKA in rheumatic AF.

  • C. Aspirin alone

    Aspirin does not adequately prevent cardioembolic stroke.

  • D. Warfarin with target INR 2 to 3 (correct)

    Correct. Warfarin is the drug of choice in AF with significant rheumatic MS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Warfarin with target INR 2 to 3. DOACs were inferior to warfarin in patients with rheumatic mitral stenosis (INVICTUS) and in mechanical valves.

Why is "Dabigatran" not the answer?

Dabigatran is not recommended in this setting.

Why is "Rivaroxaban" not the answer?

Rivaroxaban did worse than VKA in rheumatic AF.

Why is "Aspirin alone" not the answer?

Aspirin does not adequately prevent cardioembolic stroke.

What concept does this question test?

It tests Cardiology: anticoagulation in valvular AF in General Medicine. Vitamin K antagonists remain the standard in valvular AF of this type. Aspirin alone is insufficient for stroke prevention.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: anticoagulation in valvular AF?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.