Selection of Antithrombotic Therapy in Patients with Atrial Fibrillation and Percutaneous Coronary Intervention

Background: In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy has been shown to effectively prevent stent thrombosis and other ischemic cardiovascular events. The frequent occurrence of atrial fibrillation (AF) and concomitant CAD in the same individuals, suggests that clinicians will encounter many patients treated with PCI who will require anticoagulant treatment for the prevention of the thromboembolic complications of AF. Methods: In this narrative review we provide an overview and update of evidence regarding antiplatelet therapy in patients with AF undergoing PCI. Results: The combination of dual antiplatelet therapy with anticoagulants may further protect a patient from ischemic complications, at the cost, however, of a several-fold increased bleeding risk. The introduction of novel pharmaceutical agents in both categories implies that there is paucity of data regarding the efficacy and, more importantly, the safety of between-drug combinations. Conclusion: Careful consideration of the patient's individual characteristics and assessment of the risk for bleeding and thrombotic events using validated risk prediction tools is of great importance in order to maximize the benefits for each patient, while minimizing the risk for hemorrhage.