Is It Really Safe to Discontinue Antiplatelet Therapy 12 Months After Percutaneous Coronary Intervention in Patients with Atrial Fibrillation?

The prevalence of AF in patients with coronary artery disease is high. The guidelines from many professional groups, including the European Society of Cardiology, American College of Cardiology/American Heart Association and Heart Rhythm Society, recommend a maximum duration of 12 months of combination single antiplatelet and anticoagulation therapy in patients who undergo percutaneous coronary intervention and who have concurrent AF, followed by anticoagulation alone beyond 1 year. However, the evidence that anticoagulation alone without antiplatelet therapy adequately reduces the well-documented attritional risk of stent thrombosis after coronary stent implantation is relatively sparse, particularly given that very late stent thrombosis (>1 year from stent implantation) is the commonest type. By contrast, the elevated risk of bleeding from combined anticoagulation and antiplatelet therapy is clinically important. The aim of this review is to assess the evidence for longterm anticoagulation alone without antiplatelet therapy 1 year post-percutaneous coronary intervention in patients with AF.

Automated summary

The prevalence of AF is high in patients with coronary artery disease. Guidelines recommend combination single antiplatelet and anticoagulation therapy for 12 months after percutaneous coronary intervention, followed by anticoagulation alone. However, the evidence for anticoagulation alone in reducing stent thrombosis risk is limited, while combined therapy increases the risk of bleeding.