Long-term antithrombotic therapy in patients with atrial fibrillation and PCI: antiplatelets are fired

Approximately 1 in 5 patients with atrial fibrillation (AF) undergoes percutaneous coronary intervention (PCI)1. Antithrombotic therapy in this population remains challenging, because antiplatelet and anticoagulant agents are generally prescribed together to prevent platelet-mediated coronary events (myocardial infarction, stent thrombosis) and cardioembolic events (mainly stroke); however, combining these agents increases the risk of bleeding1. Several randomised trials have provided substantial evidence to guide the management of AF-PCI patients during the first year after revascularisation2. Based on this evidence, current guidelines recommend triple therapy for ≤1 week, followed by dual therapy with direct oral anticoagulants (DOACs) plus single antiplatelet therapy (SAPT; preferably clopidogrel) as the default strategy1. Complete discontinuation of antiplatelet therapy is recommended (class I, level of evidence A) at 12 months after acute coronary syndrome or at 6 months after elective PCI1. However, the evidence supporting long-term oral anticoagulation (OAC) monotherapy in AF-PCI patients is not conclusive. Cardiologists are often hesitant to stop all antiplatelet medications, even long after PCI, mainly because of concerns about stent thrombosis. Hence, substantial numbers of AF-PCI patients continue to...