Management of direct oral anticoagulants in patients with atrial fibrillation undergoing cardioversion

Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real "epidemic phenomenon". Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. This, whether obtained with synchronized shock or with drugs, involves a periprocedural risk of stroke and systemic embolism which is reduced by adequate anticoagulant therapy in the weeks before or by the exclusion of left atrial thrombi. Direct oral anticoagulants are safe, manageable, and provide rapid onset of oral anticoagulation; they are an important alternative to heparin/warfarin from all points of view, with a considerable reduction in bleedings and increase in the safety and quality of life of patients.