Before initiating long-term anticoagulation in atrial fibrillation with a CHA2DS2-VASc score of 2, what assessment is essential?

• A. Bleeding risk assessment
• B. Echocardiogram
• C. Lipid panel
• D. Exercise stress test

Answer: (A)

Assess bleeding risk before starting long-term anticoagulation in atrial fibrillation. Even when stroke risk (as shown by CHA2DS2-VASc) supports anticoagulation, evaluating bleeding risk with a tool like HAS-BLED helps identify modifiable factors (uncontrolled hypertension, renal/hepatic dysfunction, prior bleeding, labile INRs, age, concomitant drugs or alcohol) and guides safer therapy and close monitoring. Echocardiography, lipid panels, and exercise stress tests don’t directly influence the decision to initiate anticoagulation in this scenario.