{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T19:45:35Z","timestamp":1785786335946,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic therapy (TAT), and clopidogrel alone during the subsequent 6- to 12-month period of double antithrombotic therapy (DAT). Both direct and indirect data support the recommendation to avoid the more potent P2Y12 inhibitors\u2014ticagrelor and prasugrel\u2014as part of TAT, owing to the increased risk of bleeding. There is less and inconclusive data available regarding the safety and efficacy of DAT when ticagrelor or prasugrel are used instead of clopidogrel. Also, there is very limited evidence for the use of aspirin instead of clopidogrel in a DAT regimen. While acknowledging the safety and effectiveness of the recommended strategies above, it would, nonetheless, be valuable to have alternative options in the choice of antiplatelet agents. In case of very high thrombotic risk, especially when stents are positioned in potentially risky sites (such as the left main or last remaining vessel) a more potent P2Y12 inhibitor than clopidogrel may be warranted. Moreover, non-responsiveness to, or pharmacological interactions of, clopidogrel may hamper its efficacy. In this review, we aim at presenting and discussing the evidence supporting the current recommendations for the use of the various antiplatelet agents in AF patients on OAC undergoing PCI, as well as at giving a glimpse at future perspectives.<\/jats:p>","DOI":"10.3390\/jcm14176331","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T08:43:54Z","timestamp":1757493834000},"page":"6331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antiplatelet Therapy in Atrial Fibrillation Patients on Direct Oral Anticoagulants Undergoing Percutaneous Coronary Intervention: Which and How"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-2963","authenticated-orcid":false,"given":"Luca","family":"Martini","sequence":"first","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Lisi","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine and Cardiology\u2014AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziella","family":"Pompei","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine and Cardiology\u2014AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy"},{"name":"Cardiovascular Institute, Azienda Ospedaliero\u2014Universitaria of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6597-9166","authenticated-orcid":false,"given":"Manfredi","family":"Arioti","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine and Cardiology\u2014AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bendandi","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine and Cardiology\u2014AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6089-5614","authenticated-orcid":false,"given":"Michael Y.","family":"Henein","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy"},{"name":"Imperial College London, London SW3 6LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cameli","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rubboli","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine and Cardiology\u2014AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy"},{"name":"Faculty of Medicine, University of Bologna\u2014Campus of Ravenna, 48121 Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association fore Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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