Antithrombotic treatment in atrial fibrillation patients undergoing percutaneous coronary interventions: focus on stent thrombosis

Introduction: Coronary artery disease (CAD) commonly coexists with atrial fibrillation (AF), requiring oral anticoagulation (OAC) in a significant subset of patients. These patients also often require revascularization with percutaneous coronary intervention (PCI), which traditionally is supported with dual antiplatelet therapy (DAPT) to prevent complications including stent thrombosis (ST). Recent clinical studies have demonstrated that dual therapy (DAT, i.e. OAC plus single P2Y₁₂ inhibitor) has a more favorable safety profile than triple antithrombotic therapy (TAT). As none of these trials were sufficiently powered for evaluating ischemic outcomes, some concerns remain regarding ischemic complications, in particular ST, a catastrophic complication of PCI Areas covered: In this narrative review, we summarize and critically evaluate current data on the efficacy and the safety of DAT vs TAT in AF patients undergoing PCI particularly focusing on their implication in ST. Expert opinion: The choice of antithrombotic strategy in this context is challenging and requires tailored decision making with careful consideration of bleeding, thrombotic and ischemic risk for each patient. As the risk of thrombosis and bleeding varies from patient to patient, care is moving away from a ‘one size fits all’ therapy approach toward more individualized antithrombotic treatment.