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. If thrombus is seen in either atrial appendage or atrium at the time of TEE, cardioversion is post- poned, given the presumed high risk of thromboem- Table 13 [Section 4.1] Abbreviated Anticoagulation With TEE-Guided Cardioversion vs Conventional Anticoagulation for at Least 3 Weeks Before Cardioversion Anticipated Absolute Effects (Time Frame Is 8 wk) Outcomes Risk With Conventional Anticoagulation Risk Difference With Anticoagulationa (95% CI) Relative Effect No. of Participants (Studies), Follow-up Quality of The Evidence (GRADE) (0 more to 52 more) Nonfatal strokes 3 per 1,000b 5 more strokes per 1,000 (2 fewer to 38 more) Nonfatal major extracranial bleedsd (12 fewer to 9 more) ACUTE 5 Assessment of Cardioversion Using Transesophageal Echocardiography; GRADE 5 Grades of Recommendations, Assessment, Development, and Evaluation; TEE5transesophageal echocardiography. See Tables 1 and 8 for expansion of other abbreviations. aAbbreviated anticoagulation refers to either IV unfractionated heparin (started 24 h before cardioversion) or adjusted-dose warfarin (INR 2.0-3.0) (started 5 d before cardioversion). bAssumed risk is the observed event rate from the control arm (ie, conventional anticoagulation) of the RCT by Klein et al145 (ACUTE trial). cNo statistically signi cant effect, and CIs are very wide. 