AF with Recent PCI — EECC MCQ
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Correct answer: A — Triple therapy (OAC + aspirin + clopidogrel) for a short duration, then OAC + clopidogrel
This patient has atrial fibrillation with CHA₂DS₂-VASc 4, so he needs long-term oral anticoagulation for stroke prevention. However, he is also very soon after PCI with a drug-eluting stent, when antiplatelet therapy is needed to reduce stent thrombosis risk. The recommended initial strategy is therefore short-course triple antithrombotic therapy: oral anticoagulant plus aspirin plus clopidogrel. Aspirin is then stopped early because prolonged triple therapy markedly increases bleeding risk, and treatment continues as oral anticoagulant plus clopidogrel for the post-PCI period, usually up to 12 months depending on bleeding and ischaemic risk, before reverting to oral anticoagulation alone if stable. DAPT alone is inadequate because it does not provide sufficient AF-related stroke prevention, and long-term aspirin-containing triple therapy is avoided because of bleeding risk.
Reference: NICE guideline NG185, Acute coronary syndromes, recommendations on antiplatelet therapy in people with an ongoing separate indication for anticoagulation, 2020: https://www.nice.org.uk/guidance/ng185/chapter/recommendations