Antithrombotic therapy with vitamin K antagonist (VKA) and aspirin plus a P2Y12 inhibitor has been the cornerstone of medication regimen among stented patients with atrial fibrillation (AF) for decades. However, this traditional “triple therapy” (TAT) has been associated with a three to four-fold increased risk of bleeding. The ISAR Triple and WOEST Trial demonstrated that VKA in addition to one antiplatelet therapy was associated with a reduced risk of bleeding compared to the triple therapy. More recently, safety of non-Vitamin K oral anti-coagulant (NOAC)-based strategies, using a NOAC plus a P2Y₁₂ inhibitor, has been compared to vitamin K antagonist (VKA)-based triple therapy, in the PIONEER AF-PCI and REDUAL PCI randomized trials; both of which have demonstrated that NOAC-based strategies are safer and provide an attractive alternative to VKA-based triple therapy among AF patients who undergo percutaneous intervention (PCI). However, none of these randomized controlled trials was powered to assess the efficacy of dual anti-thrombotic (DAT) strategies. The higher safety associated with DAT has brought this fresh treatment modality into the limelight. Continue reading →