心房顫動患者在接受冠狀動脈支架後抗血栓藥物選擇的最新證據

International guidelines suggested stroke prevention with oral anticoagulant in patients with atrial fibrillation and CHA2DS2-VASc score over or equal to 2 points. If patient underwent percutaneous coronary intervention (PCI), then dual antiplatelet is traditionally needed to prevent stent thrombosis and major adverse cardiac events. However, triple therapy may carry greater bleeding events. After several large randomized controlled trials were completed, the answer became clear. The dual therapy with one novel oral anticoagulant plus a P2Y12 inhibitor provides reliable anti-ischemic efficacy and reduced bleeding adverse events. The 2018 North American expert consensus and 2019 ESC chronic coronary syndrome guideline also recommand triple therapy should only be used during peri-PCI period then keep dual therapy for one year after uncomplicated PCI. One year after, single oral anticoagulant should be kept for further stroke prevention. Such reducing medication strategy demostrate a good balance between efficacy and safety issues.