Do you hold anticoagulation before cardioversion?

Current AF guidelines all recommend 3 weeks of therapeutic anticoagulation with oral anticoagulation therapy (VKA, DTI, or FXa inhibitors) before cardioversion. When early cardioversion is required, all guidelines recommend TEE to exclude the presence of left atrial thrombus.

When do you start anticoagulation in cardioembolic stroke?

Objective: Guidelines recommend initiating anticoagulation within 4 to 14 days after cardioembolic stroke.

Why is anticoagulation used before cardioversion?

Anticoagulation is routinely prescribed to patients with persistent AF before cardioversion to reduce the risk of thromboembolic events.

What medication should be avoided during a cardioversion?

Blood thinners and diabetes medications Please ask your doctor how you should take your blood thinners/anticoagulants, such as Coumadin (warfarin), and your diabetes medications or insulin on the day of your cardioversion. Unless your doctor or nurse tells you otherwise, take all other regular medications as scheduled.

When do you start blood thinners after a stroke?

After a TIA or ischaemic stroke, you are likely to be given anti-platelet medication immediately. This could include aspirin, clopidogrel and dipyridamole, or a combination of aspirin and dipyridamole. After two weeks you might stay on the same type of medication, or move to an anticoagulant.

When do you start anticoagulation after a large stroke?

American Heart Association/American Stroke Association (AHA/ASA) The AHA/ASA guidelines12322 recommend that starting oral anticoagulation within4–14 days after ischaemic stroke onset is reasonable for most patients. However, a later treatment start might be considered for patients with haemorrhagic transformation.

When do strokes after cardioversion of atrial fibrillation occur?

Strokes after cardioversion of atrial fibrillation–The FibStroke study Every sixteenth stroke of patients with paroxysmal/persistent AF is preceded by a cardioversion. Most post-cardioversion strokes occur in patients not using oral anticoagulation before cardioversion of acute AF.

When to start oral anticoagulation after cardioversion of AF?

Early cardioversion in the acute phase of AF may not increase the risk of thromboembolic complications in patients already on therapeutic long-term oral anticoagulation. Because of the minor bleeding risk, short term anticoagulation should be considered also for patients with a low CHA2DS2VASc score if the delay to cardioversion is 12-48 hours.

When to consider short term anticoagulation for atrial fibrillation?

Delay of cardioversion < 12 hours from the symptom onset seems to cause a marked increase in the risk of stroke. Thus, short term anticoagulation should be considered also for patients with a low CHA2DS2VASc score if the delay to cardioversion is 12-48 hours.

When to take heparin in patients with atrial fibrillation?

Thus, the current guidelines recommend that also patients with acute atrial fibrillation should undergo cardioversion under cover of unfractionated or low-molecular weight heparin followed by oral anticoagulation for at least 4 weeks in patients at moderate-to-high risk for stroke.