Duration of triple antithrombotic therapy and clinical outcomes after percutaneous coronary intervention in atrial fibrillation

Triple antithrombotic therapy (TAT) with aspirin, a P2Y₁₂ inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) raises concerns about increased bleeding. Regimens incorporating more potent P2Y₁₂ inhibitors over clopidogrel have not been investigated adequately. A retrospective observational study was performed on 387 patients with AF receiving TAT for 1 month (<i>n</i> = 236) or ≤1 week (<i>n</i> = 151) after PCI. Major and clinically relevant non-major bleeding and major adverse cardiac and cerebrovascular events (MACCE) were assessed up to 30 days post-procedure. Bleeding was less frequent with ≤1 week versus 1 month of TAT (3.3 vs 9.3%; <i>p</i> = 0.025) while MACCE were similar (4.6 vs 4.7%; <i>p</i> = 0.998). No differences in bleeding or MACCE were observed between ticagrelor/prasugrel and clopidogrel regimens. For patients receiving ≤1 week of TAT, no excess of MACCE was seen in the subgroup given no further aspirin post-PCI compared with those given aspirin for up to 1 week (3.6 vs 5.2%). TAT post-PCI for ≤1 week was associated with less bleeding despite greater use of ticagrelor/prasugrel but similar MACCE versus 1-month TAT. These findings support further studies on safety and efficacy of dual therapy with ticagrelor/prasugrel immediately after PCI.