Anticoagulation Considerations in Patients With Chronic Lymphocytic Leukemia Atrial Fibrillation

A 76-year-old woman with chronic lymphocytic leukemia on ibrutinib is noted to be in asymptomatic atrial fibrillation (AF) on a routine electrocardiogram performed in the hematology clinic for consideration of randomized controlled trial participation.

Background history includes:

  • Hypertension
  • Obesity (body mass index 35 kg/m2)
  • Hyperlipidemia
  • Nonobstructive coronary artery disease

Current medications include:

  • Aspirin 81 mg once daily
  • Hydrochlorothiazide 25 mg once daily
  • Atorvastatin 20 mg once daily
  • Omega-3 fatty acids 1 tablet twice daily

Laboratories performed at today's visit reveal:

  • White blood cell count 12,000/mL, hemoglobin 10 mg/dL, platelets 150,000/mcL
  • Estimated glomerular filtration rate 60ml/min/m2

Which one of the following is the best strategy for anticoagulation in this patient?

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