For patients with AF of documented duration of 48 h or less undergoing elective cardioversion (electrical or pharmacologic), we suggest starting anticoagulation at presentation (low-molecular-weight heparin or unfraction- ated heparin at full venous thromboembolism treatment doses) and proceeding to cardio- version rather than delaying cardioversion for 3 weeks of therapeutic anticoagulation or a TEE-guided approach (Grade 2C). After suc- cessful cardioversion to sinus rhythm, we rec- ommend therapeutic anticoagulation for at least 4 weeks rather than no anticoagulation, regard- less of baseline stroke risk (Grade 2C). Decisions about long-term anticoagulation after cardio- version should be made in accordance with our risk-based recommendations for long-term antithrombotic therapy in section 2.1. 4.2. For patients with AF and hemodynamic instability undergoing urgent cardioversion (electrical or pharmacologic), we suggest that therapeutic-dose parenteral anticoagulation be started before cardioversion, if possible www.chestpubs.org CHEST / 141 / 2 / FEBRUARY, 2012 SUPPLEMENT e535S frequent blood testing and clinic visits. For recommendations about patients with AF and stable coronary artery disease, intra- coronary stent placement, or recent ACS (sections 3.1-3.3), we also considered the effect of different treatment options on the outcome of nonfatal myocardial infarction (MI). 1.2 Patient Values and Preferences In developing our treatment recommendations, we attempted to account for patient values and preferences regarding these health states. In this guideline, a systematic review of studies assessing values and preferences related to antithrombotic therapy found that values for health states and preferences for treatments vary appreciably among individuals (MacLean et al9). The avail- able literature has several limitations. The studies eliciting prefer- ences were small and used different methods and tools, and most included a sizeable proportion of participants who had previ- ously taken or were currently taking VKAs. 