These have been systematically reviewed as part of the 2014 and 2018 joint European consensus documents, endorsed by the Heart Rhythm Society and the Asia-Paci c Heart Rhythm Society, which provides consensus recommendations on optimal management of such patients.92,277 A similar North American expert consensus document has been O O C O O O C O Dual therapy with OAC plus inhibitor up to 12 mo. Triple therapy up to if possible. A. Balanced thrombotic/ bleeding risk B. High bleeding risk/low thrombotic risk C. High thrombotic risk/ low bleeding risk Time from treatment Initiation (eg, stent placed) mo mo mo mo Beyond mo Triple therapy OAC alone A Dual therapy with OAC plus inhibitor up to 12 mo. Triple therapy up to 6 mo if possible. Triple therapy A Oral anticoagulant with VKA (TTR >70%) or NOAC Aspirin Clopidogrel A C C Dual therapy with OAC plus inhibitor up to 12 mo. Text C O C Figure 6 A-C, Management of oral antiplatelet therapy in patients with (A) balanced thrombotic/bleeding risk, (B) low thrombotic/high bleeding risk, and (C) high thrombotic/low bleeding risk. See Figure 1 legend for expansion of abbreviations. (Adapted from Angiolillo et al.202 ) 1168 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] In a systematic review and meta-analysis (18 studies with 20,456 patients with AF; 7,203 patients received DAPT VKA and 13,253 patients received DAPT after PCI/stenting), Chaudhary et al280 showed that DAPT and VKA were associated with signi cantly lower risk of stroke, stent thrombosis, and all-cause mortality, but the risk of major bleeding was signi cantly higher in the DAPT and VKA group. 