For patients with AF receiving oral anticoagulation who undergo place- ment of an intracoronary stent, the dilemma arises about whether patients should be continued on oral anticoagulation during the time they are recom- mended to be on dual antiplatelet therapy, given the lack of direct evidence from RCTs addressing this question. Treatment decisions in this scenario must balance the effect of each drug combination on (1) the risk of stroke, systemic embolism, and mortality due to AF; (2) the risk of recurrent MI (including stent throm- bosis); and (3) the risk of bleeding related to anti- thrombotic therapy. Because of the very high risk for bias in the available observational studies that com- pare cardiovascular event rates in patients receiving triple therapy vs dual antiplatelet therapy after stent placement,115-120 we have instead used indirect evi- dence from relevant RCTs to inform our recommen- dations. We assumed that the relative impact of triple therapy on death, nonfatal MI, and nonfatal major extracranial bleeds compared with dual antiplatelet therapy would be similar to that seen in 10 RCTs of warfarin plus aspirin compared with aspirin in patients with ACS.121 For nonfatal stroke and systemic embo- lism, we assumed that the relative impact of triple therapy vs dual therapy would be similar to that seen in the ACTIVE W trial, which compared war- farin vs aspirin plus clopidogrel in patients with AF (Table 6).80 This assumption may be underestimating the true effect of triple therapy on stroke and systemic embolism compared with dual therapy. We used the same annual baseline event rates (ie, on dual antiplatelet therapy) for death, nonfatal stroke, and systemic embolism as were used in the evidence pro le comparing VKA to aspirin plus clo- pidogrel in the general AF population (Table 6). 