The Living Guidelines: Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion: Polling Results for CLASS IIa Guidelines

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Class IIa Guidelines
1. During the first 48 h after onset of AF, the need for anticoagulation before and after cardioversion may be based on the patient’s risk of thromboembolism. (Level of Evidence: C)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 1 for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 2. As an alternative to anticoagulation prior to cardioversion of AF, it is reasonable to perform TEE in search of thrombus in the LA or LAA. (Level of Evidence: B) <

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2 for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 2a. For patients with no identifiable thrombus, cardioversion is reasonable immediately after anticoagulation with unfractionated heparin (e.g., initiate by intravenous bolus injection and an infusion continued at a dose adjusted to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value until oral anticoagulation has been established with a vitamin K antagonist (e.g., warfarin), as evidenced by an INR equal to or greater than 2.0.). (Level of Evidence: B)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 2a 1. Thereafter, oral anticoagulation (INR 2.0 to 3.0) is reasonable for a total anticoagulation period of at least 4 wk, as for patients undergoing elective cardioversion. (Level of Evidence: B)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a-1 for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 2a-2. Limited data are available to support the subcutaneous administration of a low molecular weight heparin in this indication. (Level of Evidence: C)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a-2 for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 2b. For patients in whom thrombus is identified by TEE, oral anticoagulation (INR 2.0 to 3.0) is reasonable for at least 3 week prior to and 4 week after restoration of sinus rhythm, and a longer period of anticoagulation may be appropriate even after apparently successful cardioversion, because the risk of thromboembolism often remains elevated in such cases. (Level of Evidence: C)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2b for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III 3. For patients with atrial flutter undergoing cardioversion, anticoagulation can be beneficial according to the recommendations as for patients with AF. (Level of Evidence: C)

 ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 3 for pharmacological cardioversion of atrial fibrillation should be: CLASS I CLASS IIa CLASS IIb CLASS III