<span style="mso-ansi-language: EN-GB;">Short-Term Anticoagulation Post Cardioversion in New-Onset Atrial Fibrillation and a Low Thromboembolic Risk: <span style="mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">A Real-World International Investigation<span style="mso-ansi-language: EN-GB;">

Background and Objectives: Contrasting indications exist across official guidelines regarding the administration of short-term (4 weeks) oral anticoagulation (OAC) after acute cardioversion (CV), i.e. &lt;12-48 hours of atrial fibrillation (AF), in patients at low thromboembolic risk (CHA2DS2-VA= 0). The Authors sought to understand real-world clinical preferences in the setting of short-term OAC after acute CV and to which extent AF guidelines translate into clinical practice. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for, and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher&rsquo;s exact test p= 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to CV being performed more often in Europe vs Canada (p=0.006) and in long-term rhythm control, with first-line PVI being offered more frequently by European cardiologists (p= 0.013). No statistically significant association was found with regard to guideline adherence for OAC administration (p=0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA2DS2-VA=0), acutely cardioverted AF patients varies significantly amongst healthcare systems. Reducing the time limit to safely not prescribe OAC to &lt; 12 hours, caring for local access to direct oral anticoagulants (DOACs) and regional stroke risk profiles and actively preventing haemorrhage in patients receiving short-term OAC could all limit CV-related complications in this low-risk population.