For patients undergoing a TEE-guided approach, low-molecular-weight heparin at full VTE treatment doses or IV unfractionated heparin (to maintain an activated partial thromboplastin time prolongation cardioversion than an INR of 2.5 (0.93% vs 0%, P 5 .012) suggests the importance of maintaining a therapeutic INR in the pericardioversion period.140 After cardioversion, results of observational studies suggest that the highest risk of stroke and thrombo- embolism is in the rst 72 h after cardioversion and that the majority of thromboembolic complications will occur within 10 days of cardioversion.141 How- ever, TEE studies have demonstrated that despite restoration of sinus rhythm on the ECG, atrial mechanical dysfunction may persist for several weeks A nonrandomized comparison of 1,270 patients enrolled in the RE-LY trial who underwent 1,983 car- dioversions suggests that there may be no excess harm with dabigatran compared with warfarin when used for pericardioversion anticoagulation. Most cardioversions in this study (80%) were performed after the protocol-assigned study anticoagulant was given for a minimum of 3 weeks before the proce- dure, and rates of stroke and systemic embolism at 30 days after cardioversion were low when oral anti- coagulation with either warfarin or dabigatran was with dabigatran 110 mg bid, dabigatran 150 mg bid, and warfarin, respectively).143 A TEE-guided approach with abbreviated antico- agulation before cardioversion is an alternative to the conventional approach of using a minimum of 3 weeks therapeutic precardioversion anticoagulation.144 Under a TEE-guided strategy, patients receive anticoagula- tion and once therapeutic, undergo screening TEE. 