Why the study?
Anticoagulation is recommended after cardioversion of acute AF in patients with stroke risk factors, but guideline implementation has been slow.
Population
2,481 patients undergoing 5,116 successful cardioversions for AF lasting <48 h without anticoagulation or heparin
Comparison
Incidence and risk factors of thromboembolic complications without oral anticoagulation or peri-procedural heparin
Design
Multicenter observational cohort study across 3 hospitals
Follow-up
30 days
Key result
Cardioversion of acute atrial fibrillation without anticoagulation was associated with a 0.7% (95% CI 0.5-1.0%) 30-day incidence of thromboembolic events, with highest risk in heart failure and diabetes.
Authors
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Female sex and old age increase the risk of thromboembolic complications after electrical cardioversion of recent onset (< 48 hours) atrial fibrillation especially when delay to cardioversion > 12 hours. Moreover, women with a high risk of stroke were unsatisfactorily treated with oral anticoagulation.”
May support anticoagulation post-cardioversion in acute AF; leaves open need for prospective confirmation.
Cohort (n=2,481)
Yes
The incidence of thromboembolic complications after cardioversion of acute atrial fibrillation without anticoagulation is significant, particularly in patients with heart failure and diabetes, supporting the need for anticoagulation in high-risk subgroups.
Airaksinen et al. (2013) conducted a cohort in Acute atrial fibrillation (n=2,481). Cardioversion without anticoagulation was evaluated on Definite thromboembolic events within 30 days (95% CI 0.5 to 1.0). Cardioversion of acute atrial fibrillation without anticoagulation was associated with a 0.7% (95% CI 0.5-1.0%) 30-day incidence of thromboembolic events, with highest risk in heart failure and diabetes.