Cardioversion in Atrial Fibrillation

A patient presents to clinic due to one week of fatigue and palpitations, as well as intermittent episodes of lightheadedness. She is a 70-year-old woman with a history of treated obstructive sleep apnea, hypertension, coronary artery disease, and myocardial infarction three years ago. She has never had a syncopal episode. An EKG is done in clinic, and she is diagnosed with new onset atrial fibrillation. On exam, her heart is irregularly irregular, and her heart rate is in the 70s at rest. She is normotensive and euvolemic on exam.

Recent labs show that her creatinine clearance is 68 mL/min, and her hemoglobin/hematocrit are normal. The patient has concerns with frequent lab testing that would be necessary with warfarin. The decision is made to schedule a cardioversion.

What anticoagulation strategy would be preferred?

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