What is the recommended anticoagulation strategy for patients with AF and hemodynamic instability undergoing urgent cardioversion?
For patients with AF and hemodynamic instability undergoing urgent cardioversion (electrical or pharmacologic), after successful cardioversion to sinus rhythm, we recommend therapeutic anticoagulation (with VKA or full adherence to NOAC therapy) for at least 4 weeks rather than no anticoagulation, regardless of baseline stroke risk (Weak recommendation, low quality evidence). Initiation of anticoagulation therapy should not delay any emergency interventions required in order to stabilize the patient.