Choosing antithrombotic regimens for patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) with stent placement is challenging. Until recently, the guidelines recommended warfarin-based triple therapy, which causes frequent major bleeding events in up to 12% of patients during the first year of treatment. The WOEST trial, however, revealed that dual therapy, by without aspirin, resulted in significantly lower bleeding risks with similar thromboembolic events to triple therapy. Subsequently, efforts to seek the optimal dual therapy regimens, especially with the combination of a non-vitamin K antagonist oral anticoagulant (NOAC), were initiated. This review highlights the evidence for dual therapy using an NOAC for patients with AF who underwent PCI, with an emphasis on reduced bleeding risk.
Anticoagulants ; Aspirin ; Atrial Fibrillation ; Hemorrhage ; Humans ; Percutaneous Coronary Intervention ; Stents

Background: In patients with atrial fibrillation (AF), most biomarkers are still of limited use due to cost-effectiveness and complexity in clinical practice.
Hypotheses
Biomarkers from routine blood tests improve the current risk stratification in AF patients. Methods: This prospective study enrolled 600 patients diagnosed with non-valvular AF, of whom 537 were analyzed. Platelet count; platelet distribution width (PDW); red cell distribution width (RDW); and creatinine, D-dimer, and troponin I levels were measured at enrollment. Results: During the mean follow-up period (2.2 ± 0.6 years), 1.9% patients developed ischemic stroke. According to the optimal cutoff of each biomarker, the risk of ischemic stroke was higher in patients with RDW ≥ 13.5%, creatinine ≥ 1.11 mg/dL, or PDW ≥ 13.2% (significant biomarkers; P value: < 0.01, 0.04, or 0.07, respectively). These 3 significant biomarkers had higher information gain than clinical risk factors in predicting ischemic stroke. The cumulative incidence of ischemic stroke was 1.2%, 1.1%, 8.4%, and 40.0% in patients with 0, 1, 2, and 3 significant biomarkers, respectively (P-for-trend < 0.001). Patients with  ≥ 2 significant biomarkers had a significantly higher risk of ischemic stroke than those with  < 2 significant biomarkers (adjusted hazard ratio 11.5, 95% confidence interval 3.3–40.2, P < 0.001). The predictability for ischemic stroke was significantly improved when  ≥ 2 significant biomarkers were added to the CHA2DS2–VASc score (area under the curve 0.790 vs. 0.620, P = 0.043). Conclusion Routine blood tests can provide better risk stratification of AF along with clinical risk factors.