Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation
<i>Background and Objectives</i>: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA<sub>2</sub>DS<sub>2</sub>-VA =...
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2025-06-01
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| author | Alan Poggio Andrew P. Sullivan Lorenzo Rampa Jason G. Andrade Matteo Anselmino |
| author_facet | Alan Poggio Andrew P. Sullivan Lorenzo Rampa Jason G. Andrade Matteo Anselmino |
| author_sort | Alan Poggio |
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| description | <i>Background and Objectives</i>: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA<sub>2</sub>DS<sub>2</sub>-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. <i>Materials and Methods</i>: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with <i>Google Forms 2024</i> (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. <i>Results</i>: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test <i>p</i> = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (<i>p</i> = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (<i>p</i> = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (<i>p</i> = 0.120). <i>Conclusions</i>: The real-world antithrombotic management of low-risk (CHA<sub>2</sub>DS<sub>2</sub>-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population. |
| format | Article |
| id | doaj-art-16108956cfd846489e52e666dd2e786e |
| institution | DOAJ |
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| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-16108956cfd846489e52e666dd2e786e2025-08-20T02:47:13ZengMDPI AGMedicina1010-660X1648-91442025-06-01617120010.3390/medicina61071200Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International InvestigationAlan Poggio0Andrew P. Sullivan1Lorenzo Rampa2Jason G. Andrade3Matteo Anselmino4Department of Clinical and Biological Sciences, MedInTO—Medicine and Surgery, University of Turin, 10125 Turin, ItalyUBC Division of Cardiology, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, CanadaDepartment of Arrhythmology and Electrophysiology, IRCCS Ospedale San Raffaele, 20132 Milan, ItalyUBC Division of Cardiology, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, CanadaDivision of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, 10125 Turin, Italy<i>Background and Objectives</i>: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA<sub>2</sub>DS<sub>2</sub>-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. <i>Materials and Methods</i>: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with <i>Google Forms 2024</i> (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. <i>Results</i>: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test <i>p</i> = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (<i>p</i> = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (<i>p</i> = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (<i>p</i> = 0.120). <i>Conclusions</i>: The real-world antithrombotic management of low-risk (CHA<sub>2</sub>DS<sub>2</sub>-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population.https://www.mdpi.com/1648-9144/61/7/1200atrial fibrillationcardioversionshort-term oral anticoagulationthromboembolismstrokebleeding |
| spellingShingle | Alan Poggio Andrew P. Sullivan Lorenzo Rampa Jason G. Andrade Matteo Anselmino Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation Medicina atrial fibrillation cardioversion short-term oral anticoagulation thromboembolism stroke bleeding |
| title | Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation |
| title_full | Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation |
| title_fullStr | Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation |
| title_full_unstemmed | Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation |
| title_short | Short-Term Anticoagulation After Cardioversion in New-Onset Atrial Fibrillation and Low Thromboembolic Risk: A Real-World International Investigation |
| title_sort | short term anticoagulation after cardioversion in new onset atrial fibrillation and low thromboembolic risk a real world international investigation |
| topic | atrial fibrillation cardioversion short-term oral anticoagulation thromboembolism stroke bleeding |
| url | https://www.mdpi.com/1648-9144/61/7/1200 |
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