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Updated: Feb 15, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Triple Antithrombotic Therapy for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Mathieu Kerneis1, Usama Talib1, Tarek Nafee1

  • 1PERFUSE Study Group, Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.

Progress in Cardiovascular Diseases
|February 6, 2018
PubMed

Insights

For patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), non-vitamin K oral anticoagulant (NOAC)-based triple therapy significantly reduces bleeding risk compared to traditional warfarin regimens.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis

Background:

  • Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI).
  • Atrial fibrillation (AF) patients undergoing PCI often require oral anticoagulants (OACs) alongside DAPT.
  • Traditional triple therapy (OAC + DAPT) significantly increases bleeding risk.

Purpose of the Study:

  • To review the rationale and evidence for triple antithrombotic therapy in AF patients post-PCI.
  • To evaluate non-vitamin K OAC (NOAC)-based strategies versus warfarin-based regimens.

Main Methods:

  • Review of randomized trials, including PIONEER AF-PCI and REDUAL PCI.
  • Comparison of NOAC-based triple therapy with vitamin K antagonist (VKA)-based triple therapy.

Main Results:

  • NOAC-based strategies demonstrated superior safety profiles.
  • Reduced bleeding risk observed with NOAC-based triple therapy compared to VKA-based therapy.

Conclusions:

  • NOAC-based triple antithrombotic therapy is a safer alternative for AF patients undergoing PCI.
  • These findings support a shift from traditional VKA-based triple therapy.

Keywords:
Atrial fibrillationNovel oral anticoagulationPercutaneous coronary interventionReviewRivaroxaban

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