Dual antithrombotic therapy with dabigatran and ticagrelor in patients with acute coronary syndrome and non-valvular atrial fibrillation undergoing percutaneous coronary intervention (ADONIS-PCI): protocol for a randomized controlled pilot trial

Introduction

Patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) require protection against both cardioembolic and coronary thrombotic events, while facing a substantial bleeding risk. Oral anticoagulation (OAC) reduces the risk of stroke and systemic embolism but does not adequately address stent-related thrombotic risk. Conversely, dual antiplatelet therapy reduces recurrent coronary ischemic events and stent thrombosis but is insufficient for AF-related thromboembolism. Current antithrombotic strategies therefore rely on abbreviated triple antithrombotic therapy followed by dual antithrombotic therapy; however, the optimal P2Y12 inhibitor and dosing strategy in patients with AF and ACS treated with PCI remain uncertain.