The Next Phase in Anticoagulation for Cardioversion of Patients with Atrial Fibrillation

In patients undergoing elective cardioversion for atrial fibrillation (AF), standard anticoagulation lasts for 3 weeks before and 4 weeks after the procedure. When a transesophageal echocardiogram (TEE) excludes left-atrial thrombus, cardioversion can be performed safely without preprocedural (but not without postprocedural) anticoagulation in these patients.

In a manufacturer-funded multinational trial, researchers randomized 2199 patients (AF duration, 2 days to 1 year) undergoing elective cardioversion to receive enoxaparin–warfarin or the direct oral anticoagulant edoxaban (60 mg/day or, in appropriate patients, reduced-dose 30 mg/day). Local investigators chose whether to use 3 weeks of preprocedural anticoagulation or a more-immediate …