Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Rankin, A. J. and Rankin, S. H. (2017) Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal. Clinical Medicine, 17(5), pp. 419-423. (doi: 10.7861/clinmedicine.17-5-419) (PMID:28974590)

Abstract

Current guidelines support the well-established clinical practice that patients who present with atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer significant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratification in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHA2DS2-VASc score may allow better selection of appropriate patients in order to prevent exposing specific patient groups to an unacceptably high risk of a potentially devastating complication.

• Item Type: Articles
• Keywords: Anticoagulants, atrial fibrillation, cardioversion, electrical cardioversion, stroke, thromboembolism.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rankin, Dr Stephen and Rankin, Dr Alastair
• Authors: Rankin, A. J., and Rankin, S. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Medicine
• Publisher: Royal College of Physicians
• ISSN: 1470-2118
• ISSN (Online): 1473-4893
• Copyright Holders: Copyright © 2017 Royal College of Physicians
• First Published: First published in Clinical Medicine 17(5):419-423
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher