Background. Current guidelines recommend dual antithrombotic therapy (DAT) with a NOAC and a clopidogrel as standard of care in patients with non-valvular atrial fibrillation (nv-AF) undergoing PCI. Little is known about how these recommendations are followed in clinical practice and if there are differences between patients undergoing elective PCI or PCI for acute coronary syndromes (ACS)

Methods. We performed a prospective registry in 51 hospitals with consecutive patients with nv-AF undergoing PCI with stent implantation. Baseline characteristics, procedural features, concomitant medications and in-hospital events were centrally collected and analysed in all patients.

Results. Between 01/2018 and 01/2020 a total of 1636 patients were enrolled. The indications for PCI were elective in 52%, unstable angina in 28 %, NSTEMI in 21 % und STEMI in 9 %. A dual combination therapy consisting of oral anticoagulation and a P2Y12 inhibitor was given in 72 %, triple therapy in 26 % and a mono therapy in 2 % of patients. Clopidogrel 75 mg (n=1557, 95.2 %) was the most often used antiplatelet, followed by aspirin 100 mg (n=521, 31.8 %), while prasugrel (0.4 %) and ticagrelor (2.5 %) were given only rarely. When patients were divided into two groups depending on their indication for PCI, namely elective PCI (n= 860) and PCI for an acute coronary syndrome (n=776) some differences in the use of combination therapy were observed. Patients with ACS received more often DAPT only (7.9 % versus 3.4 %, p< 0.001), more often triple therapy (30.4 % versus 22.0 %, p< 0.001) and less often dual therapy (59.3 % versus 72.6 %, p< 0.001). The duration of there different combination therapies are shown in in the figure. 

Conclusions: In patients with nv-AF undergoing PCI dual therapy with a NOAC and clopidogrel is the preferred antithrombotic combination therapy. However , there are large differences regarding the intensity and duration of combination therapy between patients with elective PCI and PCI for ACS.