Which anticoagulation treatments can be administered to patients with atrial fibrillation (Afib) (AF) awaiting electrical cardioversion?

Updated: Apr 09, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Patients with newly diagnosed AF and patients awaiting electrical cardioversion can be started on intravenous heparin (activated partial thromboplastin time [aPTT] of 45-60 seconds) or low-molecular-weight heparin (LMWH) (1 mg/kg twice daily [BID]).

Patients can be started concomitantly on warfarin in an inpatient setting while awaiting a therapeutic international normalized ratio [INR] value (2-3). Many practices have developed specialized anticoagulation clinics to monitor INR values closely. Newer oral anticoagulants are attractive alternatives to warfarin in patients with nonvalvular AF. These agents include dabigatran, rivaroxaban, apixaban, and edoxaban, and they can be started without the need for an anticoagulation bridge with heparin or LMWH before cardioversion.


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