A growing number of patients undergoing
percutaneous coronary intervention (PCI) with
stent implantation also have
atrial fibrillation. This poses challenges for their optimal antithrombotic management because patients with
atrial fibrillation undergoing PCI require oral anticoagulation for the prevention of cardiac
thromboembolism and dual antiplatelet
therapy for the prevention of coronary thrombotic complications. The combination of oral anticoagulation and dual antiplatelet
therapy substantially increases the risk of
bleeding. Over the last decade, a series of North American Consensus Statements on the Management of Antithrombotic
Therapy in Patients with
Atrial Fibrillation Undergoing
Percutaneous Coronary Intervention have been reported. Since the last update in 2018, several pivotal clinical trials in the field have been published. This document provides a focused updated of the 2018 recommendations. The group recommends that in patients with
atrial fibrillation undergoing PCI, a non-
vitamin K antagonist oral
anticoagulant is the oral anticoagulation of choice. Dual antiplatelet
therapy with
aspirin and a P2Y12 inhibitor should be given to all patients during the peri-PCI period (during inpatient stay, until time of discharge, up to 1 week after PCI, at the discretion of the treating physician), after which the default strategy is to stop
aspirin and continue treatment with a P2Y12 inhibitor, preferably
clopidogrel, in combination with a non-
vitamin K antagonist oral
anticoagulant (ie, double
therapy). In patients at increased thrombotic risk who have an acceptable risk of
bleeding, it is reasonable to continue
aspirin (ie, triple
therapy) for up to 1 month. Double
therapy should be given for 6 to 12 months with the actual duration depending on the ischemic and
bleeding risk profile of the patient, after which patients should discontinue antiplatelet
therapy and receive oral anticoagulation alone.