The decision about long- term anticoagulant therapy (beyond 4 weeks) is based on the thromboembolic risk profile (Section 4) and bleeding risk profile. The 48-hour rule has also been questioned, because delay to car- dioversion of 12 hours or longer from symp- tom onset was associated with a greater risk of thromboembolic complications compared to cardioversion of less than 12 hours (1.1% versus and the risk of thromboembolic com- plications with cardioversion of 12 hour or longer increases substantially in patients >75 years of age and in women.S6.1.1-19 4. The data supporting the safety of current prac- tices of cardioversion of AF without oral anticoag- ulation in patients with AF duration <48 hours are limited. Two recent retrospective studies demon- strate that the risk of thromboembolic complica- tion after a cardioversion for AF lasting <48 hours is in the range of 0.7% to 1.1%, with higher risk in patients with risk factors that include female sex, HF, and diabetes mellitus, whereas patients <60 years of age without thromboembolic risk factors and those with postoperative AF appear to have a lower risk.S6.1.1-13,S6.1.1-14 cardioversions in 484 patients), the risk of throm- boembolism was nearly 5 times higher in patients without therapeutic anticoagulation than in those on therapeutic anticoagulation with either warfa- rin or heparin. All events in that study occurred in patients with a CHA2 -VASc score of 2.S6.1.1-14 In the absence of randomized trials, the risk of thromboembolic events should be weighed against the risk of anticoagulant-related bleeding for the individual patient. 6. Two recent retrospective studies evaluated the risk of thromboembolism in patients after cardio- version for AF lasting <48 hours. 