The incidence of the composite ef cacy end point of thromboembolic events (MI, stroke, or systemic embolism), death, or unplanned revascularization was 13.7% in the 2 dual-therapy groups combined compared with 13.4% in the triple- therapy group (HR, 1.04; 95% CI, 0.84-1.29; P .005 for noninferiority). Thus, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. In contrast to the PIONEER-AF trial, the RE-DUAL PCI trial tested dabigatran doses (110 mg and 150 mg bid) which are licensed for stroke prevention in AF. There are limited data on the use of the newer P2Y12 inhibitors (ticagrelor, prasugrel) with OAC. Observational cohorts in AF patients report a higher bleeding rate where these newer APT agents are used as part of a triple-therapy regimen, compared with when clopidogrel is used as part of the triple-therapy Only a minority of patients in PIONEER AF-PCI had newer P2Y12 agents, whereas the largest experience in AF patients was in the RE-DUAL PCI trial, which allowed ticagrelor in combination with dabigatran 110 mg or 150 mg bid. In the GEMINI-ACS-1 trial (A randomized trial to compare the safety of rivaroxaban vs aspirin in addition to either clopidogrel or ticagrelor in acute coronary 3,037 patients with ACS (ie, essentially a non-AF population) were randomly assigned to either aspirin 100 mg or rivaroxaban 2.5 mg bid, and the subsequent choice of clopidogrel (44%) or ticagrelor (in 56%) during trial conduct was nonrandomized. 