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In the context of managing an irregular heart rhythm, particularly in an elderly patient with a history of palpitations, the initiation of anticoagulation therapy is critical to reduce the risk of thromboembolic events, such as stroke, associated with conditions like atrial fibrillation.

Rivaroxaban is an oral direct factor Xa inhibitor that is commonly used for anticoagulation in patients with non-valvular atrial fibrillation. By inhibiting factor Xa, Rivaroxaban helps prevent the formation of blood clots that could arise from stagnant blood flow in the heart's chambers, especially in an irregular rhythm. This is a significant concern in older adults, who are at higher risk for both atrial fibrillation and subsequent strokes.

Meanwhile, while aspirin has some antiplatelet properties, it is not sufficient as a sole anticoagulation strategy in patients with atrial fibrillation and does not adequately address the stroke risk. Digoxin is primarily used for rate control in certain arrhythmias but does not provide prophylaxis against stroke. Lisinopril, an ACE inhibitor, is mainly indicated for hypertension and heart failure management and does not address the underlying rhythm issue or thromboembolic prevention.

Thus, starting Rivar