19. Which of the following drugs is recommended for prophylaxis of thromboembolism in a patient with atrial fibrillation and severe mitral valve regurgitation?

A. Dabigatran

B. Rivaroxaban

C. Warfarin

D. Aspirin

E. Choices A, B or C

Dabigatran, apixiban and rivaroxaban are not indicated for “valvular atrial fibrillation” since these patients were not included in the trials that resulted in FDA approval of these agents. Regardless of a patients CHADS 2 Vasc score, valvular atrial fibrillation requires full anticoagulation, thus aspirin alone is not correct.