[Cardiology] Pre-anticoagulation before TEE/DCCV

[Category] Topic; 1. Workup; 2. Management; 3. Tip and Teaching point; 4. References;

[Uptodate] 

[TEE/DCCV - suggested approach even there was no difference between conventional and TEE approach; but more bleeding in conventional approach]

If a thrombus is seen on TEE, the patient should receive a minimum of four weeks of therapeutic anticoagulation and a repeat TEE to document thrombus resolution if cardioversion is desired [28]. If no cardioversion is desired, a follow-up TEE is not needed, as the patient should receive lifelong antithrombotic therapy. If thrombus is absent on repeat TEE, cardioversion may be performed. If thrombus is still evident, the rhythm control strategy may be changed to a rate control strategy, especially when AF-related symptoms are controlled, since there is a high risk of thromboembolism if cardioversion is performed. However, the evidence supporting this latter recommendation of avoidance of cardioversion with a residual thrombus is minimal.

It is best to be conservative with at least three weeks of pre-cardioversion oral anticoagulant if an atrial thrombus cannot be confidently excluded on TEE.