Anticoagulation before cardioversion of acute atrial fibrillation in the emergency department
Report By: Katherine Potier - Specialist Registrar in Emergency Medicine
Search checked by Richard Parris - Locum Consultant
Institution: Manchester Royal Infirmary
Date Submitted: 17th September 2004
Date Completed: 12th April 2005
Last Modified: 6th January 2005
Status: Green (complete)
Three Part Question
In a patient with [acute atrial fibrillation undergoing cardioversion in the emergency department] does [anticoagulation immediately before cardioversion] [reduce the incidence of thrombo-embolism]?
A 58 year old man presents to the emergency department with a 24 hour history of new onset AF. You decide to cardiovert him in the department (chemically or electrically) and wonder whether he needs to be anticoagulated prior to this to reduce any thromboembolic risks.
Medline 1966-12/04 using the OVID interface and The Cochrane Library, Issue 4, 2004.
Medline: [exp Atrial fibrillation OR AF.mp OR atrial fibrillation.mp] AND [exp electric countershock OR cardioversion.mp OR exp anti arrhythmia agents/ OR chemical cardioversion.mp] AND [exp heparin OR heparin.mp OR exp heparin, low molecular weight OR low molecular weight heparin.mp OR fractionated heparin.mp OR bemiparin.mp OR certoparin.mp OR dalteparin.mp OR oxaparin.mp OR reviparin.mp OR tinzaparin.mp OR fragmin.mp OR clexane.mp] LIMIT to human AND English language.
Cochrane: (atrial fibrillation) AND (anticoagulation) AND (cardioversion)
Altogether 54 papers were found of which non are relevant to the question.
Anticoagulation is recommended before cardioversion of AF lasting more than 2 days to avoid thromboembolic complications. However there is little evidence from the literature to support its use in AF of shorter duration.
Clinical Bottom Line
There is no evidence at present to support using anticoagulation prior to the (medical or electrical) cardioversion of new onset AF.