Cardioversion of atrial fibrillation is a procedure that has been commonly performed for over half a century. There is known to be an elevated risk of thromboembolism around the time of cardioversion, which has been shown to be drastically reduced with oral anticoagulation. The consistency of therapeutic anticoagulation in the weeks leading up to elective cardioversion is an important factor in the safety of the procedure. Until recently, the only option for oral anti-coagulation was Warfarin. The challenges of dosing Warfarin to achieve a therapeutic INR are well documented. In recent years, novel oral anticoagulant medications have been developed, which are thought to provide a consistent intensity of anticoagulation and do not require routine monitoring or dose adjustment. The purpose of this review is to examine the literature pertaining to a comparison of Warfarin versus novel oral anti-coagulants with respect to time of elective cardioversion.
Credits: Siva Krothapalli; Prashant D. Bhave