CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 186 AFRICA Conclusion Based on previously published randomised and observational studies, NOACs appear to be an effective and safe alternative to VKA in patients undergoing cardioversion for AF. However, we must remember that there is a group of patients (about 5%) who will develop a LAA thrombus despite oral anticoagulation treatment, which is comparable in the NOAC and VKA groups. The presence of thrombi in this location is associated with an increased risk of peripheral embolism, mainly stroke. However, performing cardioversion in these patients can be particularly dangerous. There are known predictors of LAA thrombus occurrence; however, it is still difficult to identify patients with LAA thrombus without imaging. Therefore, there is an ongoing discussion about the routine performance of TTE, particularly in the NOAC-treated population. 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