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Best evidence topic reports
Anticoagulation before cardioversion of acute atrial fibrillation in the emergency department
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  1. Katherine Potier, Specialist Registrar in Emergency Medicine,
  2. Richard Parris, Locum Consultant

    Abstract

    A short cut review was carried out to establish whether anticoagulation is indicated prior to emergency department cardioversion of a patient with acute onset atrial fibrillation. 54 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

    http://dx.doi.org/10.1136/emj.2005.023531

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      Report by Katherine Potier, Specialist Registrar in Emergency Medicine 
 Checked by Richard Parris, Locum Consultant

      Clinical scenario

      A 58 year old man presents to the emergency department with a 24 hour history of new onset AF. You decide to cardiovert him in the department (chemically or electrically) and wonder whether he needs to be anticoagulated prior to this to reduce any thromboembolic risks.

      Three part question

      In a patient with [acute atrial fibrillation undergoing cardioversion in the emergency department] does [anticoagulation immediately before cardioversion] [reduce the incidence of thrombo-embolism]?

      Search strategy

      Medline 1966-12/04 using the OVID interface and The Cochrane Library, Issue 4, 2004.

      Medline: [exp Atrial fibrillation OR AF.mp OR atrial fibrillation.mp] AND [exp electric countershock OR cardioversion.mp OR exp anti arrhythmia agents/OR chemical cardioversion.mp] AND [exp heparin OR heparin.mp OR exp heparin, low molecular weight OR low molecular weight heparin.mp OR fractionated heparin.mp OR bemiparin.mp OR certoparin.mp OR dalteparin.mp OR oxaparin.mp OR reviparin.mp OR tinzaparin.mp OR fragmin.mp OR clexane.mp] LIMIT to human AND English language.

      Cochrane: (atrial fibrillation) AND (anticoagulation) AND (cardioversion)

      Search outcome

      Altogether 54 papers were found, of which none are relevant to the question.

      Relevant paper(s)

      No relevant papers given.

      Comment(s)

      Anticoagulation is recommended before cardioversion of AF lasting more than 2 days to avoid thromboembolic complications. However there is little evidence from the literature to support its use in AF of shorter duration.

      CLINICAL BOTTOM LINE

      There is no evidence at present to support using anticoagulation prior to the (medical or electrical) cardioversion of new onset AF.