We evaluated the effectiveness of early direct oral
anticoagulant (DOAC) monotherapy within one year after
percutaneous coronary intervention (PCI) in patients with
atrial fibrillation (AF) using Korean National Health Insurance Service data. AF patients who underwent PCI were included and divided into the DOAC monotherapy group and the combination therapy group (DOAC with an
antiplatelet agent) based on the medications used at 6 months after PCI. A major adverse cardiovascular event (
MACE) was defined as a composite of cardiovascular death, acute
myocardial infarction (AMI),
stroke, or systemic thromboembolic event between 6 and 12 months after PCI. In the overall study population, the DOAC
dose reduction rate was high in both the monotherapy group (70.8%) and the combination therapy group (79.1%). After propensity score matching, the
MACE incidence was not significantly different between the two groups (hazard ratio [HR] 1.42 [0.90-2.24]). The numerical trend for higher
MACE in the monotherapy group was mainly driven by the difference in
stroke incidence (HR 1.84 [0.97-3.46]). All-cause death (HR 1.29 [0.61-2.74] or the incidence of major
bleeding (HR 1.07 [0.49-2.35]) results were similar in the two groups. In conclusion, early DOAC monotherapy was not significantly associated with
MACE risk between 6 and 12 months after PCI.