Thursday, July 1, 2021

Thromboembolic Events After Cardioversion

REBEL EM - Written July 01, 2021 - By Miguel Reyes
Paper: Wong BM et al. Thromboembolic Events Following Cardioversion of Acute Atrial Fibrillation and Flutter: A Systematic Review and Meta-Analysis. CJEM 2021. PMID: 33715143.
Clinical Question: What is the effect of oral anticoagulation use on thromboembolic events at 30 days following cardioversion of acute atrial fibrillation and flutter?
Author’s Conclusion: Primary analysis revealed insufficient evidence regarding the effect of oral anticoagulation use on thromboembolic events post-cardioversion of low-risk acute atrial fibrillation and flutter, though the vent rate is low in contemporary practice. Our finding can better inform patient-centered decision-making when considering 4-week oral anticoagulation use for acute atrial fibrillation and flutter patients.”
Clinical Bottom Line:
This systematic review and meta-analysis tells us that thromboembolic events in patients with acute onset atrial fibrillation and flutter post-cardioversion are exceedingly low at 30 days. There is insufficient evidence regarding the value of oral anticoagulation in low-risk acute afib and aflutter patients post-cardioversion. However, based on this limited evidence it does appear as though the event rate in those not receiving oral anticoagulation post-cardioversion is very low. More importantly, I’m reluctant to deviate from the recommendations from both the American and European guidelines and will continue to anticoagulant those with higher risk (CHADS2 ≥1 and CHA2DS2-VASc ≥2).