Advantages and disadvantages of the conventional approach to cardioversion (one month of pretreatment with warfarin) in patients with atrial fibrillation

Advantages	Disadvantages
Use of warfarin for one month before cardioversion may lower the stroke rate from 5.6 percent to a very low stroke rate of <2 percent.	Delaying cardioversion to normal sinus rhythm for one month potentially decreases functional capacity.
Relatively easy to administer with regular monitoring of INRs.	Prolonging treatment for seven to eight weeks one month prior to and one month after cardioversion increases the risk of bleeding complications.
Suitable for community hospitals.	Not followed by routine clinical practice, especially in the elderly.
The conventional approach has withstood the "test of time" since the 1960s.	Patients who are at the highest risk for developing systemic embolization who should receive more prolonged or intensive anticoagulation are not routinely identified.

Reprinted with permission from the American College of Cardiology. J Am Coll Cardiol 2001; 37:691. https://www.journals.elsevier.com/journal-of-the-american-college-of-cardiology.

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