Short-term anticoagulation after acute cardioversion of early-onset atrial fibrillation

Controversy exists regarding anticoagulation management following acute cardioversion in patients with early-onset (<48 hours) atrial fibrillation without class I guideline indication for long-term oral anticoagulation (CHA2DS2-VASc 0-1).

A random-effect meta-analysis of observational studies reporting 30-day incidence of thromboembolic complications after cardioversion without post-procedural oral anticoagulation therapy in patients at low-moderate thromboembolic risk (CHA2DS2-VASc 0-1) was performed. Four studies were included, encompassing 3276 cardioversions. The analysis revealed that the pooled risk of 30-day incidence of thromboembolic complications in this subset of patients is low (0.10%, 95% confidence interval: 0.00%-0.30%).

Given these data, considering the bleeding risk unavoidably conferred by OAT, which is known to be higher in the first month from treatment onset, short-term anticoagulation limited to 4 weeks post-cardioversion of early-onset (<48 hours) atrial fibrillation in patients with low-moderate risk of stroke (CHA2DS2-VASc 0-1) may be omitted, at least in patients with high-bleeding risk.