Hi Norbi, in order to make sure you reduce cardioembolic risk, you need a more effective anticoagulating drug, such as VKA ( with therapeutic INR) or NOAC (no measurements required). LMWH does not require blood checks as well but is less effective in reducing thrombus formation when used alone.

Dear Colleague,

There was no evidence regarding the safety and efficacy of LMWHs without TEE control in patients undergoing ECV. Also there was no recommendation at which dose and how much time interval? However, we used to prefer administration of LMVHs before ECV in anticoagulant naive patients with the control of TEE (without LA or LAA thrombi).

Yours sincerely,

Ugur

Greetings Norbi

Mostly LMWHs trial would be related with deep vein thrombosis not with atrial fibrillation. At the moment, no evidence showed that LMWHs alone could reduce LA clot. In NOAC trials, they only compare with warfarin. 

in practice, some physician would use LMWHs due to simple dosage and administration. Nevertheless LMWHs need no further laboratory evaluation for normal patients.

Hope it helps

thanks