Table 6.

Consensus recommendations for antithrombotic management of patients with atrial fibrillation after percutaneous coronary intervention

Hemorrhage risk	Clinical setting	Stroke riska	Recommendations for antithrombotic therapy
			Timing of treatment after PCI	Therapy	Details
Low or moderate (HAS-BLED ≤2)	Stable CAD (elective PCI)	Moderate	≥4 weeks <6 months	Triple therapyb	Reduced-dose OAC + ASA + clopidogrel
			Up to 12th month	Dual therapyc	Reduced-dose OAC + clopidogrel or Reduced-dose OAC + ASA
			Lifelong	Single therapy	Standard-dose OACd
		High	≥4 weeks <6 months	Triple therapye	Reduced-dose OAC + ASA + clopidogrel
			Up to 12th month	Dual therapy	Reduced-dose OAC + clopidogrel or Reduced-dose OAC + ASA
			Lifelong	Single therapy	Standard-dose OACd
	ACS (urgent PCI)	Moderate	Up to 6th month	Triple therapy	Reduced-dose OAC + ASA + clopidogrel
		or high	Up to 12th month	Dual therapyf	Reduced-dose OAC + clopidogrel or Reduced-dose OAC + ASA
			Lifelong	Single therapy	Standard-dose OACd
High (HAS-BLED ≥3)	Stable CAD (elective PCI)	Moderate	Up to 12th month	Dual therapyc	Reduced-dose OAC + clopidogrel
			Lifelong	Single therapy	Standard-dose OACd
		High	4 weeks	Triple therapyb	Reduced-dose OAC + ASA + clopidogrel
			Up to 12th month	Dual therapy	Reduced-dose OAC + clopidogrel or Reduced-dose OAC + ASA
			Lifelong	Single therapy	Standard-dose OACd
	ACS	Moderate	4 weeks	Triple therapye	Reduced-dose OAC + ASA + clopidogrel
	(urgent PCI)	or high	Up to 12th month	Dual therapy	Reduced-dose OAC + clopidogrel or Reduced-dose OAC + ASA
			Lifelong	Single therapy	Standard-dose OACd

Notes: Unless specified, ASA dose is 75–100 mg/day and clopidogrel dose is 75 mg/day. Reduced-dose OAC refers to either a VKA with a target INR of 2.0–2.5 or direct OAC at the lowest tested dose in AF (apixaban 2.5 mg bid, rivaroxaban 15 mg od, or dabigatran 110 mg bid). Tailored guidance for patients with AF already on a reduced dose of direct OAC before a PCI is not given.

^aStroke risk assessed via CHA₂DS₂-VASc; moderate risk is defined as a score of 1, high risk is defined as a score of ≥2; only male patients with AF undergoing PCI can be defined as moderate risk – female patients with AF undergoing PCI will have a CHA₂DS₂-VASc score of ≥2;

^bcombination of reduced-dose OAC + clopidogrel 75 mg/day or dual antiplatelet therapy consisting of ASA 75 mg/day and clopidogrel 75 mg/day may be considered as an alternative;

^cdual antiplatelet therapy consisting of ASA 75 mg/day and clopidogrel 75 mg/day may be considered as an alternative;

^din selected patients (eg, those with stenting of the left main proximal bifurcation, or recurrent myocardial infarctions), dual therapy with OAC and single antiplatelet therapy may be continued beyond 12 months;

^ecombination of OAC and clopidogrel 75 mg/day may be considered as an alternative;

^fin selected patients at high stroke risk, continuation of triple therapy between 6 and 12 months may be considered. Data from Lip et al.⁶⁴

Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; ASA, acetylsalicylic acid; bid, twice daily; CAD, coronary artery disease; CHA₂DS₂-VASc, Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥75 years (2 points), Diabetes, Stroke or transient ischemic attack previous event/thromboembolism (2 points), Vascular disease, Age 65–74 years, and Sex category (female); INR, international normalized ratio; OAC, oral anticoagulant; od, once daily; PCI, percutaneous coronary intervention; VKA, vitamin K antagonist; HAS-BLED, Hypertension, Abnormal Liver Function, Stroke History, Bleeding Predisposition, Labile INRs, Elderly, Drugs Concomitantly.