心房顫動患者計算CHA2DS2-VASc分數大於兩分便需要抗凝血藥物來預防中風，當這群病人接受冠狀動脈支架置放後需要抗血小板藥物來減少支架血栓及未來心血管不良事件，如此情況下多重藥物的使用以及出血副作用的問題一直困擾著臨床醫師。在近年各個大型臨床試驗陸續完成後，有足夠的證據顯示支架置放後以新型口服抗凝血藥物NOAC (Novel oral anticoagulant)加上一種P2Y12抑制劑這樣雙重治療便可以有可靠的療效，及早停止aspirin的使用可以減少出血的副作用。目前北美與歐洲的指引也開始跟著修正，建議若進行的心導管介入並不複雜，僅在置放支架一週內使用NOAC加上DAPT (Dual-antiplatelet therapy)三種藥物治療，接著僅需使用兩種藥物持續至一年，一年過後就單一使用抗凝血藥物來同時預防中風及其他心血管不良事件。如此減少藥物的策略將同時提供可靠的心血管保護力也兼具減少出血的安全性。

International guidelines suggested stroke prevention with oral anticoagulant in patients with atrial fibrillation and CHA2DS2-VASc score over or equal to 2 points. If patient underwent percutaneous coronary intervention (PCI), then dual antiplatelet is traditionally needed to prevent stent thrombosis and major adverse cardiac events. However, triple therapy may carry greater bleeding events. After several large randomized controlled trials were completed, the answer became clear. The dual therapy with one novel oral anticoagulant plus a P2Y12 inhibitor provides reliable anti-ischemic efficacy and reduced bleeding adverse events. The 2018 North American expert consensus and 2019 ESC chronic coronary syndrome guideline also recommand triple therapy should only be used during peri-PCI period then keep dual therapy for one year after uncomplicated PCI. One year after, single oral anticoagulant should be kept for further stroke prevention. Such reducing medication strategy demostrate a good balance between efficacy and safety issues.