What is the recommended anticoagulation strategy for individuals at risk for stroke during cardioversion?
For individuals at risk for stroke during cardioversion, the recommended anticoagulation strategy is to initiate VKA (INR, 2.5; range, 2.0-3.0) followed by a TEE and subsequent cardioversion scheduled 5 days later (if the INR is in therapeutic range at that time). Alternatively, NOACs can be used in the outpatient setting, with no bridging therapy necessary. If atrial thrombus is seen on TEE, then there is heterogeneity in current clinical practice regarding both when or whether to perform the TEE again, as well as subsequent management of anticoagulation.