The conundrum of simultaneous antiplatelet and anticoagulant therapy: how to solve it?

Abstract Antiplatelet therapy is the cornerstone of secondary prevention of coronary artery disease, and dual antiplatelet therapy (DAPT) has become the standard of care of patients undergoing percutaneous coronary intervention (PCI) with coronary stenting and of patients with acute coronary syndromes (ACSs) with or without stent implantation. In patients with non-ST-segment elevation ACS, 1 year of treatment is recommended. In elective patients, 6 months of DAPT is preferred by most cardiologists, but prolonged treatment can be given with more complex anatomy or the use of multiple stents. To reduce bleeding in patients on simultaneous antiplatelet and anticoagulant therapy, combining oral anticoagulation and antiplatelet monotherapy with a P2Y12 inhibitor without aspirin has become a reality. Furthermore, the wide application of non–vitamin K antagonist oral anticoagulants in patients with atrial fibrillation has made PCI safer.