Non-vitamin K anticoagulants are at least as efficient as vitamin K-antagonists in preventing thromboembolic complications after cardioversion in atrial fibrillation patients.
Is cardioversion within a 48-hour time window without prior anticoagulation safe in patients with atrial fibrillation?
This review challenges the traditional practice of performing cardioversion within 48 hours of atrial fibrillation onset without prior anticoagulation, suggesting early cardioversion be reserved only for hemodynamically unstable patients.
There is a considerable periprocedural risk of thromboembolic events in atrial fibrillation patients undergoing cardioversion, and treatment with anticoagulants is therefore a hallmark of cardioversion safety. Based on retrospective subgroup analyses and prospective studies, non-vitamin K anticoagulants are at least as efficient as vitamin K-antagonists in preventing thromboembolic complications after cardioversion. The risk of thromboembolic complications after cardioversion very much depends on the comorbidities in a given patient, and especially heart failure, diabetes, and age >75 years carry a markedly increased risk. Cardioversion has been considered safe within a 48-h time window after onset of atrial fibrillation without prior treatment with anticoagulants, but recent studies have set this practice into question based on e.g. erratic debut assessment of atrial fibrillation. Therefore, a simple and more practical approach is here suggested, where early cardioversion is performed only in hemodynamically unstable patients.
Khatami et al. (Wed,) conducted a review in Atrial fibrillation undergoing cardioversion. Non-vitamin K anticoagulants vs. Vitamin K-antagonists was evaluated on Thromboembolic complications. Non-vitamin K anticoagulants are at least as efficient as vitamin K-antagonists in preventing thromboembolic complications after cardioversion in atrial fibrillation patients.