A 76-year-old female with atrial fibrillation requires chronic therapy. What medication should be initiated?

Warfarin is the medication of choice for chronic therapy in a patient with atrial fibrillation, especially in an older adult like the 76-year-old female in this scenario. The primary goal in managing atrial fibrillation is to reduce the risk of thromboembolic events, particularly stroke, which is significantly increased in patients with this arrhythmia. Warfarin is an anticoagulant that effectively decreases the risk of clot formation by inhibiting vitamin K-dependent clotting factors, thus providing the necessary prophylaxis against strokes.

In older patients, it is essential to carefully manage anticoagulation due to the risk of bleeding; however, with proper monitoring of INR levels, warfarin remains a reliable option for long-term anticoagulation in this demographic.

While other choices such as verapamil, amiodarone, and digoxin have roles in the management of atrial fibrillation, they do not serve the same primary purpose as warfarin. Verapamil is primarily a calcium channel blocker used for rate control; amiodarone is an antiarrhythmic that can be used for rhythm control but does not provide anticoagulation; digoxin can help with rate control but is not effective as an anticoagul