Sotomi Y, et al. - In this single-center prospective observational registry of nonvalvular atrial fibrillation (NVAF) patients treated with direct oral anticoagulants (DOACs) (the DIRECT registry), researchers assessed the incremental bleeding risk of add-on antiplatelet therapy to DOACs. They analyzed 2,216 NVAF patients who used dabigatran (N=648), rivaroxaban (N=538), apixaban (N=599), or edoxaban (N=431) from June 2011 to November 2017 (71.6±10.8 years, 36.4% female, follow-up duration: 407.2±388.3 days). A total of 1,739 patients were given no add-on antiplatelet agent. A total of 411 and 66 patients received single and dual antiplatelet therapy (SAPT and DAPT) in combination with DOAC, respectively. Findings revealed a significantly higher bleeding risk in NVAF patients treated with antiplatelet agents and DOAC vs those using DOAC only. However, adding antiplatelet therapy to DOAC itself did not impact bleeding risk, after adjustment of patients’ background.