DISCUSSION
bleeding, dabigatran‐based, thrombotic
EVENTS, BLEEDING
OPTIMA‐4 trial is the first large‐scale RCT investigating the optimal P2YTATT was proposed for ACS patients with concomitant AF after PCI to prevent major adverse cardiovascular events (MACEs) over a decade ago.PLATO trial demonstrated that for ACS patients treated with clopidogrel plus aspirin, the risk of major bleeding not related to coronary‐artery bypass grafting was significantly decreased compared with those treated with ticagrelor plus aspirin.To evaluate the benefit‐risk balance, the primary endpoints of OPTIMA‐4 trial contain both safety and efficacy endpoints. The primary safety endpoint is set as major bleeding and CRNMB, which is consistent with the relevant RCTs,The hierarchical statistical procedure is first based on the hypotheses that the clopidogrel group is superior to the ticagrelor group regarding the safety endpoint, and then noninferior to the latter regarding the efficacy endpoint. This design mainly concerns the major bleeding and CRNMB under DATT, which may result in unexpected discontinuation of antithrombotic agents and consequent increase of the ischemic risk.The main inclusion and exclusion criteria are set on the basis of the following considerations. First, as only new‐generation DES is required to be implanted in this trial, and the high thrombotic risk scenario such as left main coronary artery DES implantation will be excluded, it would be acceptable to initiate DATT within 5 days after PCI, instead of after 1‐week  1‐month TATT. Second, because all enrolled patients will receive dabigatran‐based DATT, they need to meet the criteria of CHA