When do you Anticoagulate AFib?

Although most recommendations suggest an IRM monitoring strategy between two and four 24-hour IRM per year for the detection of AF recurrence, most statements simultaneously note that these strategies have a limited sensitivity and a significant proportion of patients with AF recurrence will not be detected.

New-onset atrial fibrillation (AF) is a new or first detectable episode of a chaotic and irregular atrial arrhythmia . Prevalence increases progressively with age.

Based on these observations, it is generally recommended that anticoagulation be instituted for three weeks before cardioversion is attempted in patients with AF of more than two days’ duration . To minimize thromboembolic complications, anticoagulants should be continued for four weeks after cardioversion.

Contemporary North American and European guidelines recommend that the clinical pattern of atrial fibrillation (AF) be classified based on episode duration and persistence, with AF defined as paroxysmal if episode duration is less than 7 days and persistent if the episode duration is 7 days or longer .

For patients with AF or atrial flutter of 48 hours’ duration or longer, or when the duration of AF is unknown, anticoagulation with warfarin (INR 2.0 to 3.0), a factor Xa inhibitor, or direct thrombin inhibitor is recommended for at least 3 weeks before and at least 4 weeks after cardioversion.