⚡ Anticoagulation Management for AF Cardioversion
This tool gives the peri-cardioversion anticoagulation strategy for atrial fibrillation by AF duration and hemodynamic stability.
Anticoagulation Management for AF Cardioversion
AF duration
Hemodynamically unstable
When to use
Use to decide pre-cardioversion anticoagulation (or TEE) and the mandatory post-cardioversion course, separating unstable patients who need immediate cardioversion.
How it works
Unstable → immediate cardioversion, anticoagulate ASAP. < 48 h → anticoagulate at presentation, low-risk may cardiovert directly. ≥ 48 h/unknown → anticoagulate ≥ 3 weeks or TEE-exclude thrombus. All → ≥ 4 weeks after cardioversion.
Key points
- Anticoagulation continues at least 4 weeks after cardioversion regardless of duration or stroke risk, because of thrombus risk during atrial stunning. (original synthesis · not guideline verbatim)
- Long-term anticoagulation is decided by CHA₂DS₂-VASc, not by whether sinus rhythm was achieved.
- A left-atrial-appendage thrombus on TEE defers cardioversion for 4–12 weeks of anticoagulation.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.