Balancing Bleeding and Ischemic Risks: A Systematic Review of Dual Versus Triple Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation

This systematic review evaluates the comparative efficacy and safety of dual versus triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. A comprehensive literature search identified four randomized controlled trials encompassing diverse populations and treatment strategies. Dual therapy, consisting of a non-vitamin K oral anticoagulant combined with a single P2Y12 inhibitor, consistently demonstrated a reduction in bleeding complications compared to conventional triple therapy without compromising protection against ischemic events such as myocardial infarction, stroke, or stent thrombosis. While the larger multicenter trials provided robust evidence supporting the safety of early aspirin withdrawal, smaller trials were limited by sample size and early termination, restricting the generalizability of their findings. Nevertheless, the overall evidence suggests that dual therapy should be considered the preferred approach for most patients, with triple therapy reserved for carefully selected individuals at high ischemic risk where a short course may provide incremental benefit. These findings support the growing shift in clinical practice toward individualized antithrombotic strategies that optimize both safety and efficacy in this complex patient population.