It may also suit patients who would prefer to avoid prolonged oral anticoagulation before cardioversion and those at increased risk for bleeding. However, the ability to avoid anticoagulation with a TEE-guided strategy is most relevant for patients without stroke risk factors and at low risk of recurrent AF in whom long-term anticoagulation beyond 4 weeks after car- dioversion would not be required. 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. 