IF AF WAS CONVERTED TO SINUS, when to stop warfarin and when to stop amiodarone?
It depends on the CHA2DS2-VASc Score. If if it is less than 1 - 1 month after the cardioversion
Regarding anticoagulant therapy we can refer to the ESC guideline (attachment below). It states "For patients with AF of 48 h duration or longer, or when the duration of AF is unknown, OAC therapy (INR 2.0–3.0) is recommended for at least 3 weeks prior to and for 4 weeks after cardioversion, regardless of the method (electrical or oral/i.v. pharmacological). (Recommendation I B) However, The stroke and thrombo-embolic risk in paroxysmal AF is less well defined, and such patients have represented the minority (usually 30%) in clinical trials of thromboprophylaxis. Stroke risk in paroxysmal AF is not different from that in persistent or permanent AF,12 and is dependent upon the presence of stroke risk factors . Therefore, patients with paroxysmal AF should receive OAC according to their risk score."
There is no precise timing when to stop amiodarone if we are using it for rhythm control but in my opinion when there is no evidence of AF recurrence and when side affects arises.
Dear Dr.
It is advised to continue warfarin for two months then depending on risk factors.
Best regards
Dr. Hyder O. Mirghani
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