Combined antithrombotic regimens for
atrial fibrillation (AF) patients with
coronary artery disease, particularly for those who have
acute coronary syndrome (ACS) and/or are undergoing
percutaneous coronary intervention (PCI), presents a great challenge in the real-world clinical scenario. Conventionally, a triple antithrombotic
therapy (TAT), which consists of combined oral
anticoagulant therapy to prevent systemic
embolism or
stroke along with dual antiplatelet
therapy to prevent coronary arterial
thrombosis (CAT), is used. However, TAT has been associated with a significantly increased risk of
bleeding. With the emergence of non-
vitamin K antagonist oral
anticoagulants (NOACs), randomized controlled trials have demonstrated a better risk-to-benefit ratio of dual antithrombotic
therapy (DAT) in combination of a
NOAC and with a P2Y12 inhibitor than
vitamin K antagonist-based TAT. The results of these studies have impacted the recommendations of current international guidelines, which favor a DAT with a
NOAC and P2Y12 inhibitor (especially
clopidogrel) in this clinical setting. Additionally,
aspirin can be administered during the periprocedural period, while the
treatment duration of TAT should be as short as possible. In this article, we summarize the up-to-date evidence regarding antithrombotic regimens for AF patients with PCI or ACS, with a specific focus on the optimal approach and critical discussions of key scientific data and future developments for antithrombotic management in these patients.