How long should anticoagulation therapy be continued before and after cardioversion for atrial fibrillation?

Anticoagulation therapy is crucial in the management of atrial fibrillation (AF) before and after cardioversion to reduce the risk of thromboembolic events, particularly ischemic stroke. For patients with atrial fibrillation who are undergoing elective cardioversion, it is recommended that anticoagulation be initiated well in advance and continued for a period thereafter.

The standard guideline suggests that anticoagulation therapy should be continued for approximately three weeks prior to cardioversion. This timeframe allows for adequate prevention of thrombus formation, particularly in the left atrial appendage, where clots are more prone to develop in AF patients. Following the cardioversion procedure, anticoagulation should be maintained for at least four weeks to ensure that any potential thrombi that may have formed during the period of atrial fibrillation prior to the procedure do not result in a stroke once normal sinus rhythm is restored.

This guideline aims to mitigate the risks associated with AF and the potential complications of cardioversion, hence the recommendation of three weeks of anticoagulation before and four weeks following the procedure is justified. As such, the appropriate option for the duration of anticoagulation therapy is three weeks prior and four weeks post-cardioversion.