Anticoagulation Strategy in Patients with Atrial Fibrillation and Coronary Artery Disease

Both coronary artery disease and atrial fibrillation are common diseases. Ischemic stroke and systemic embolism are major adverse outcomes of atrial fibrillation, and antithrombotic treatment reduces the risk of thromboembolic events significantly. On the other hand, antiplatelet therapy is essential in patients with coronary artery disease. Combined antiplatelet-anticoagulant therapy is required to reduce the risk of recurrent ischemic cardiac events and stroke in patients with atrial fibrillation coexisting with coronary artery disease. However, this antithrombotic strategy is associated with an increased risk of bleeding complications. It is challenging in clinical practice to balance the risk of bleeding and thromboembolism, and to choose from oral anticoagulants and antiplatelet agents to establish an optimal strategy.