Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation

Tapio Hellman, Tuomas Kiviniemi, Ilpo Nuotio, Tuija Vasankari, Juha Hartikainen, Gregory Y. H. Lip, K. E. Juhani Airaksinen

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
134 Downloads (Pure)


Background: Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0–2.4) vs. high (INR ≥ 2.5) therapeutic range in a large retrospective cohort study.
Methods: This multi-centre “real world” study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV.
Results: Altogether 4 (0.3%) strokes, 2 (0.1%) TIAs and 2 (0.1%) bleeds were detected during the 30-day follow-up after ECV. No systemic emboli were detected. There were 2 deaths (0.1%), one associated with a stroke. Median time to stroke/TIA was 4 (IQR 9.5) days and the median CHA2DS2-VASc-score was 2 (IQR 1.25) among patients with thromboembolic events. Mean INR at ECV was 2.7 (SD 0.54) in the study cohort. Patients with INR 2.0–2.4 at ECV had more thromboembolic events compared with patients with INR ≥ 2.5 (5/529 (0.9%) vs. 1/895 (0.1%), p = 0.03). Comprehensive postprocedural INR data was available for 733 (71.8%) patients and 1007 cardioversions. At least one subtherapeutic (< 2.0) INR value was detected within 21 days after 230 (22.8%) ECVs and this drop in INR level was associated with a higher risk for thromboembolic events compared with continuous therapeutic post-cardioversion anticoagulation (1.7% vs 0.3%, p = 0.03).
Conclusions: Our results suggest that the intensity of periprocedural anticoagulation is associated with the risk of thromboembolic events after ECV.
Original languageEnglish
Pages (from-to)163-167
JournalThrombosis Research
Early online date22 Jun 2017
Publication statusPublished - 1 Aug 2017


  • atrial fibrillation
  • stroke
  • anticoagulation
  • therapeutic range
  • international normalized ratio


Dive into the research topics of 'Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation'. Together they form a unique fingerprint.

Cite this