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While bleeding risk is considerable with that approach, data for efficacy are scare. Several trials assessed the possibility of reducing anti-thrombotic treatment by mainly shortening the exposure to acetylsalicylic acid. Dropping one of the anti-platelet components might increase the risk of stent thrombosis, myocardial infarction or stroke. Despite that fear, the recent trials\u2019 primary endpoint was major and\/or clinically-relevant non-major bleeding. We review data on major bleedings, intracranial bleedings and major adverse cardiovascular events from the published reports. We demonstrate that Non-Vitamin K oral anticoagulant (NOAC)-based strategies compared to VKA-based triple therapies significantly reduce the risk for TIMI-major bleedings by 39% and for intracranial bleedings by 66%, while they did not increase the risk for overall ischemic or embolic events. However, recent meta-analyses indicate an increased risk for stent thrombosis with less intense anti-thrombotic therapy. While the overall incidence rate for stent thrombosis is rather low, relative increases by about 30\u201360% are reported, but they did not translate into adverse clinical net-benefit ratios. This review highlights that using certain NOAC regimens proven effective for stroke prevention in AF can reduce the rate of bleeding without increasing ischemic or embolic events. Furthermore, additive ASA in triple anti-thrombotic regimens should be limited to 1\u00a0month and individual weighing of ischemic versus bleeding risk during the first 30\u00a0days seems to be reasonable.<\/jats:p>","DOI":"10.1007\/s00392-020-01708-8","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T13:04:59Z","timestamp":1595336699000},"page":"759-774","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Anti-thrombotic strategies in patients with atrial fibrillation undergoing PCI"],"prefix":"10.1007","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-6162","authenticated-orcid":false,"given":"Andreas","family":"Sch\u00e4fer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Flierl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,21]]},"reference":[{"issue":"1","key":"1708_CR1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.jacc.2019.05.016","volume":"74","author":"D Capodanno","year":"2019","unstructured":"Capodanno D, Huber K, Mehran R, Lip GYH, Faxon DP, Granger CB et al (2019) Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review. 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