Ticagrelor or Clopidogrel After PCI in Atrial Fibrillation? Insights from a Real-World Retrospective Analysis

Background: Optimal antithrombotic therapy in patients with AF undergoing PCI while receiving OAC remains a clinical challenge. Although clopidogrel is generally recommended as the preferred P2Y12 inhibitor in this setting, evidence comparing clopidogrel with ticagrelor in real-world AF–PCI populations is limited. Objective: To evaluate ischemic and bleeding outcomes in AF patients treated with DOAC combined with clopidogrel, ticagrelor, or TAT following PCI for ACS. Methods: This study involved 248 consecutive patients with non-valvular AF who underwent PCI for ACS and were discharged on DOAC plus clopidogrel (Group 1), DOAC plus ticagrelor (Group 2), or aspirin + clopidogrel + DOAC (Group 3). Cox regression analysis was used to determine the difference in survival rates among the three groups regarding the composite ischemic endpoint (stroke, MI, and stent restenosis) and bleeding. Results: In the Cox regression analysis performed, no statistically significant effect of the variables representing the antiplatelet treatment groups on ischemic outcomes was observed during the 1-year follow-up (Wald = 3.681; df = 2; p = 0.159). Conclusions: In this retrospective real-world cohort of AF patients undergoing PCI for ACS, clopidogrel-based dual therapy appeared to provide clinical outcomes comparable to ticagrelor with respect to thromboembolic and bleeding events. No clear ischemic advantage of ticagrelor was observed, although a numerical increase in minor bleeding was noted.