Windecker S, Lopes RD, Massaro T, et al. - In order to determine if antithrombotic regimens have different safety and efficacy between patients with atrial fibrillation (AF) having acute coronary syndromes (ACS) treated medically or with percutaneous coronary intervention (PCI), and those undergoing elective PCI, researchers investigated 3 pre-specified subgroups including patients with ACS treated medically, ACS treated with PCI, and those undergoing elective PCI, to evaluate bleeding, death, and hospitalization as well as death and ischemic events by antithrombotic strategy in these subgroups. They used a 2×2 factorial design and compared apixaban with vitamin K antagonists (VKA) and aspirin with placebo in patients with AF who had ACS or were undergoing PCI and were taking a P2Y12 inhibitor. Enrolled patients were 4,614 in total; ACS was treated medically, with PCI, and with elective PCI in 1,097 (23.9%), 1,714 (37.3%), and 1,784 (38.8%), respectively. Findings revealed superior safety and similar efficacy of an antithrombotic regimen consisting of apixaban and a P2Y12 inhibitor without aspirin, compared with regimens that included VKAs, aspirin, or both, in patients with AF who had ACS, whether managed medically or with PCI, or those undergoing elective PCI.