Thus, it may be both safer and more effective to use NOACs compared with VKAs to treat patients with nonvalvular AF and concomitant aspirin therapy. The largest observational cohort was reported by Lamberts et al,283 which included a total of 12,165 AF patients (60.7% male; mean age, 75.6 years) hospitalized with MI and/or undergoing PCI between 2001 and 2009. Relative to triple therapy (OAC plus DAPT; ie, aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (HR, 0.69; 95% CI, 0.48-1.00), OAC plus aspirin (HR, 0.96; 95% CI, 0.77-1.19), or aspirin plus clopidogrel (HR, 1.17; 95% CI, 0.96-1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR, 1.50; 95% CI, 1.03-2.20). OAC plus aspirin and aspirin plus clopidogrel were associated with a signi cant increased risk of all- cause death (HR of 1.52 [95% CI, 1.17-1.99] and HR of with triple therapy, bleeding risk was nonsigni cantly lower for OAC plus clopidogrel (HR, 0.78; 95% CI, 0.55- 1.12) and signi cantly lower for OAC plus aspirin and aspirin plus clopidogrel. Thus, OAC and clopidogrel was equal or better for both bene t and safety outcomes compared with triple therapy. However, this analysis provides limited information on the duration of therapies, quality of INR control, stent type, underlying bleeding risk pro le, etc. Randomized Trials: Prospective RCTs in AF patients presenting with ACS and/or undergoing PCI/stenting are limited. The rst trial was the What Is the Optimal Antiplatelet and Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary Stenting which randomized 573 adults receiving OACs (65% with AF) and undergoing PCI to clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). 