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Review
. 2025 May 26;14(11):3713.
doi: 10.3390/jcm14113713.

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

Antonio Capolongo  1   2 , Vincenzo De Sio  1   2 , Felice Gragnano  1   2 , Mattia Galli  3   4 , Natale Guarnaccia  1   2 , Pasquale Maddaluna  1   2 , Giuseppe Verde  1   2 , Vincenzo Acerbo  1   2 , Pierre Sabouret  5 , Daniele Giacoppo  6 , Matteo Conte  1   2 , Silvio Coletta  1   2 , Vincenzo Diana  1   2 , Michelangelo Luciani  1   2 , Elisabetta Moscarella  1   2 , Arturo Cesaro  1   2 , Francesco Pelliccia  7 , Paolo Calabrò  1   2
Affiliations
Review

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

Antonio Capolongo et al. J Clin Med. .

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.

Keywords: P2Y12 inhibitors; PCI; antithrombotic therapy; atrial fibrillation; bleeding.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Design and main results of the randomized controlled trials in AF-PCI patients. AF, atrial fibrillation; CAD, coronary artery disease; CI, confidence interval; CRNM, clinically relevant nonmajor; DAT, dual antithrombotic therapy; DOAC, direct oral anticoagulant; HR, hazard ratio; MACCE, major adverse cardiac and cerebrovascular events; NACE, net clinical adverse events; OAC, oral anticoagulation; PCI, percutaneous coronary intervention; SAT, single antithrombotic therapy; VKAs, vitamin K antagonists.
Figure 2
Figure 2
Practical recommendations by current guidelines for patients with AF undergoing PCI. AF, atrial fibrillation; ACS, acute coronary syndrome; CCS, chronic coronary syndrome; OAC, oral anticoagulation; PCI, percutaneous coronary intervention; TAT, triple antithrombotic therapy.
See this image and copyright information in PMC

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