5th July 2026

A 50-year-old female patient with hypertrophic cardiomyopathy attended the outpatient cardiology clinic and complained of palpitations that had occurred suddenly over several weeks.

A 50-year-old female patient with hypertrophic cardiomyopathy attended the outpatient cardiology clinic and complained of palpitations that had occurred suddenly over several weeks. She described them as being irregular and can occur even at rest. Each episode can last up to 3 hours, which caused her to feel lethargic afterwards. An ECG was performed in clinic, which revealed atrial fibrillation with a heart rate of 107 bpm. Clinic blood pressure was 105/50 mm Hg, and she was clinically euvolemic on physical examination. The most recent echocardiogram showed a normal left ventricular ejection fraction but an enlarged left atrium. There is no history of alcohol excess. She was not diabetic and had never suffered a stroke before. International normalised ratio (INR), renal and liver function tests were normal. You decided to up-titrate her regular bisoprolol dose from 2.5 mg once daily to a twice-daily prescription. What would you advise her regarding the need for anticoagulation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.