Anticoagulation Management After Rhythm Restoration in Atrial Fibrillation
1. Core Principle – Rhythm Does Not Dictate Anticoagulation
2. Evidence Supporting Ongoing Anticoagulation Regardless of Rhythm
3. Post‑Cardioversion Anticoagulation Requirements
4. CHA₂DS₂‑VASc‑Guided Decision Pathway
| CHA₂DS₂‑VASc Score (Sex‑Specific) | Recommended Anticoagulation Strategy | Guideline & Strength | |
|---|---|---|---|
| Male = 0 or Female = 1 (sex point only) | Reasonable to stop anticoagulation (no antithrombotic therapy). | ACC (2014) – Class IIa (moderate recommendation). | [7] |
| Male = 1 or Female = 2 | Either continue or stop may be considered (clinical judgment). | ACC (2014) – Class IIb (weak recommendation). | [7] |
| Male ≥ 2 or Female ≥ 3 | Continue anticoagulation indefinitely; stopping is not advised. | ACC (2014) – Class I (strong recommendation). | [7] |
Scoring components (each point): congestive heart failure, hypertension, age ≥ 75 yr (2 points), diabetes, prior stroke/TIA/thromboembolism (2 points), vascular disease, age 65‑74 yr (1 point), female sex. (Praxis Clinical Summaries, 2026). 3