What are the practical issues with VKA and NOAC cardioversion?
VKA and NOAC cardioversion antithrombotic therapy for patients with AF undergoing cardioversion come with several practical issues. VKA, which is typically used in these cases, requires a therapeutic INR range of 2-3 to be achieved prior to cardioversion. This may take several weeks and requires regular monitoring to ensure that the target range is achieved. NOACs, on the other hand, have a shorter time to onset of therapeutic anticoagulation but can be difficult to reverse in cases of bleeding or the need for emergent procedures which require immediate reversal. Additionally, the doses and routes of administration of the available NOAC reversal agents can vary substantially. Therefore, careful consideration must be taken when selecting the most appropriate antithrombotic therapy for patients with AF undergoing cardioversion.  