Antithrombotic treatment management in low stroke risk patients undergoing cardioversion of atrial fibrillation <48 h duration: Results of an EHRA survey

Federico Migliore (Coresponding Author), Rui Providencia, Michal M. Farkowski, Georghe Andrei Dan, Scherr Daniel, Tatjana S. Potpara, Kristīne Jubele, Julian K.R. Chun, Carlo De Asmundis, Alessandro Zorzi, Serge Boveda

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Data supporting the safety of cardioversion (CV) of atrial fibrillation (AF) without anticoagulation in patients with AF duration <48 h are scarce. Observational studies suggest that the risk of stroke in these patients is very low when the definite duration of the AF episode is of <48 h and the clinical risk profile as estimated through the CHA2DS2VASc score is low (a score of 0 for men and 1 for women). As the recent 2020 European Society of Cardiology (ESC) guidelines indication for this clinical scenario is based mainly on consensus, we sent out a survey to assess the current clinical practice on anticoagulation prior to and post-CV in patients with AF <24-48 h duration and low stroke risk across centres in Europe. Of the 136 respondents, half were affiliated to university hospitals (68/136; 50%). Non-university hospitals (50/136; 36%) and private hospitals (2/136; 1.4%) accounted over a third of respondents. The main findings of our survey were (i) heterogeneity in the anticoagulation management both before and post-CV in low stroke-risk patients with AF <48 h, (ii) higher utilization of periprocedural low-molecular-weight heparin than of non-vitamin K antagonist oral anticoagulant, (iii) higher utilization of pre-CV transoesophageal echocardiography for electrical CV than for pharmacological CV regardless of the duration of AF, (iv) high adherence to a 4-week post-CV oral anticoagulant (OAC) therapy, mainly for electrical CV, and finally, (v) perceived higher acceptance of lack of post-CV OAC therapy in patients with <24 h than 24-48 h episode duration. The results obtained in this survey highlight the need for more research providing definitive clarification on the safety of CV without anticoagulation in patients with short duration AF.

Original languageEnglish
Pages (from-to)1502-1507
Number of pages6
JournalEuropace
Volume23
Issue number9
DOIs
Publication statusPublished - 1 Sep 2021

Keywords*

  • Anticoagulation
  • Atrial fibrillation
  • Cardioversion
  • EHRA survey
  • Low stroke risk
  • Non-vitamin K antagonist oral anticoagulants
  • Vitamin K antagonist

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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