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, but that initiation of anticoagulation must not delay any emergency intervention (Weak recommendation, low quality evidence). *18. For patients with AF and hemodynamic instability undergoing urgent cardioversion (electrical or pharmacologic), after successful cardioversion to sinus rhythm, we suggest therapeutic anticoagulation for at least 4 weeks after successful cardioversion to sinus rhythm rather than no anticoagulation, regardless of baseline stroke risk (Weak recommendation, low quality evidence). Remark: Decisions about anticoagulation beyond 4 weeks should be made in accordance with our risk- based recommendations for long-term antithrombotic therapy in recommendations 1 and 2. 1124 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] *19. For patients with atrial utter undergoing elective or urgent pharmacologic or electrical cardioversion, we suggest that the same approach to thromboprophylaxis be used as for patients with atrial brillation undergoing cardioversion (Ungraded consensus-based statement). 20. In AF patients presenting with an ACS and/or undergoing PCI/stenting, we recommend assessment of stroke risk using the CHA2DS2-VASc score (Strong recommendation, moderate quality evidence). Remark: All such patients are not low risk and should be considered for concomitant OAC. 21. In AF patients presenting with an ACS and/or undergoing PCI/stenting, we suggest attention to modi able bleeding risk factors at every patient contact, and assessment of bleeding risk using the HAS-BLED score (Weak recommendation, low quality evidence). Remark: Where bleeding risk is high (HAS-BLED $ 3), there should be more regular review and follow-up. 22. 