Long-Term Antithrombotic Therapy in Patients with Atrial Fibrillation and Percutaneous Coronary Intervention

TL;DR

This review examines the best long-term blood clot prevention strategies for patients with heart rhythm issues and heart artery procedures.

Contribution

The paper evaluates current evidence and clinical considerations for optimal antithrombotic therapy in AF patients post-PCI.

Findings

Current guidelines suggest a transition from triple to dual antithrombotic therapy after PCI.

Evidence supports oral anticoagulation monotherapy but its real-world use is inconsistent.

Key challenges include balancing ischemic and bleeding risks in long-term therapy.

Abstract

The optimal long-term antithrombotic treatment of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains controversial. Current guidelines recommend a short initial period of triple antithrombotic therapy (e.g., 1 week), followed by dual therapy consisting of an oral anticoagulation agent and a single antiplatelet agent for 6 months in patients undergoing elective PCI and 12 months in patients with acute coronary syndromes. After this course of combination therapy, anticoagulation monotherapy is recommended. In daily practice, however, the optimal strategy for long-term antithrombotic therapy remains debated. A growing body of evidence supports the safety and efficacy of oral anticoagulation monotherapy, but its use in clinical practice remains inconsistent. This review aims to evaluate the available evidence on chronic antithrombotic regimens in patients with AF undergoing PCI, with a focus on key clinical considerations, such as the selection of optimal long-term therapy that balances ischemic and bleeding risks. It also highlights that, despite robust supporting evidence, significant gaps persist in real-world implementation.

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