TY - JOUR T1 - Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal  JF - Clinical Medicine JO - Clin Med SP - 419 LP - 423 DO - 10.7861/clinmedicine.17-5-419 VL - 17 IS - 5 AU - Alastair J Rankin AU - Stephen H Rankin Y1 - 2017/10/01 UR - http://www.rcpjournals.org/content/17/5/419.abstract N2 - Current guidelines support the well-established clinical practice that patients who present with atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer significant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratification in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHA2DS2-VASc score may allow better selection of appropriate patients in order to prevent exposing specific patient groups to an unacceptably high risk of a potentially devastating complication. ER -