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)

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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.
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 > Institute of Health and 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 (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

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