When should anticoagulation therapy be administered in the treatment of atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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For episodes of atrial flutter of uncertain duration or longer than 48 hours, begin anticoagulation therapy. Rate control and therapeutic anticoagulation are required for a minimum of 4 weeks prior to cardioversion. If cardioversion is needed sooner, anticoagulate patients with intravenous (IV) heparin and perform TEE as close to the time of cardioversion as possible. Patients continue to require anticoagulation for at least 4 weeks after cardioversion. If thrombus is observed or suspected on the basis of TEE findings, delay cardioversion.

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