***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Patients receiving oral anticoagulation ( OAC ) who undergo drug-eluting stent ( DES ) implantation require additional dual antiplatelet therapy with aspirin and clopidogrel . Such triple therapy confers an elevated bleeding risk , and its optimal duration is not known . OBJECTIVES The goal of this study was to evaluate whether shortening the duration of clopidogrel therapy from 6 months to 6 weeks after DES implantation was associated with a superior net clinical outcome in patients receiving concomitant aspirin and OAC .  METHODS In this r and omized , open-label trial , we enrolled patients receiving OAC who underwent DES implantation at 3 European centers between September 2008 and December 2013 . A total of 614 patients receiving concomitant aspirin and OAC  were r and omized to either 6-week clopidogrel therapy ( n=307 ) or 6-month clopidogrel therapy ( n=307 ) . The primary endpoint was a composite of death , myocardial infa rct ion ( MI ) , definite stent thrombosis , stroke , or Thrombolysis In Myocardial Infa rct ion ( TIMI ) major bleeding at 9 months . RESULTS The primary endpoint occurred in 30 patients ( 9.8 % ) in the 6-week group compared with 27 patients ( 8.8 % ) in the 6-month group ( hazard ratio [ HR ] : 1.14 ; 95 % CI : 0.68 to 1.91 ; p=0.63 ) . There were no significant differences for the secondary combined ischemic endpoint of cardiac death , MI , definite stent thrombosis , and ischemic stroke ( 12 [ 4.0 % ] vs. 13 [ 4.3 % ] ; HR : 0.93 ; 95 % CI : 0.43 to 2.05 ; p=0.87 ) or the secondary bleeding endpoint of TIMI major bleeding ( 16 [ 5.3 % ] vs. 12 [ 4.0 % ] ; HR : 1.35 ; 95 % CI : 0.64 to 2.84 ; p=0.44 ) . CONCLUSIONS Six weeks of triple therapy was not superior to 6 months with respect to net clinical outcomes . These results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter or longer duration of triple therapy . ( Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation [ ISAR-TRIPLE ] ; NCT00776633 ) BACKGROUND Oral anticoagulation ( OAC ) is the recommended therapy for patients with atrial fibrillation ( AF ) because it reduces the risk of stroke and other thromboembolic events . Dual antiplatelet therapy ( DAPT ) is required after percutaneous coronary intervention and stenting ( PCI-S ) . In patients with AF requiring PCI-S  , the association of DAPT and OAC carries an increased risk of bleeding , whereas OAC therapy or DAPT alone may not protect against the risk of developing new ischemic or thromboembolic events . OBJECTIVE The MUSICA-2 study will test the hypothesis that DAPT compared with triple therapy ( TT ) in patients with nonvalvular AF at low-to-moderate risk of stroke ( CHADS2 score ≤2 ) after PCI-S reduces the risk of bleeding and is not inferior to TT for preventing thromboembolic complications . DESIGN The MUSICA-2 is a multicenter , open-label r and omized trial that will compare TT with DAPT in patients with AF and CHADS2 score ≤2 undergoing PCI-S.  The primary end point is the incidence of stroke or any systemic embolism or major adverse cardiac events : death , myocardial infa rct ion , stent thrombosis , or target vessel revascularization at 1 year of PCI-S. The secondary end point is the combination of any cardiovascular event with major or minor bleeding at 1 year of PCI-S. The calculated sample size is 304 patients . CONCLUSIONS The MUSICA-2 will attempt to determine the most effective and safe treatment in patients with nonvalvular AF and CHADS2 score ≤2 after PCI-S. Restricting TT for AF patients at high risk for stroke may reduce the incidence of bleeding without increasing the risk of thromboembolic complications Most evidence regarding the efficacy and safety of the antithrombotic regimens for patients with atrial fibrillation ( AF ) undergoing percutaneous coronary intervention with stent ( PCI‐S )  derives from small , single‐center , retrospective data sets . To obtain further data on this issue , we carried out the prospect i ve , multicenter , observational Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting ( AFCAS ) registry ( Clinical trials.gov identifier NCT00596570 ) Background Chronic atrial fibrillation ( AF ) , coexisting with a history of recent coronary angioplasty with stent ( PCI-S ) , represents an encoded indication for oral anticoagulation ( OAC ) with warfarin plus dual antiplatelet therapy ( DAPT ) . Methods Using a retrospective cohort study , we determined the respective impacts on cardiovascular outcomes of three different pharmacologic regimens , i.e. , triple therapy ( TT ) with warfarin + clopidogrel and aspirin , dual therapy ( DT ) with warfarin + clopidogrel or aspirin , and DAPT with clopidogrel + aspirin . Outcomes of interest were all-cause mortality , ischemic cardiac events , ischemic cerebral events , and bleeding events . The inclusion criterion was the coexistence of an indication for OAC ( e.g. , chronic AF ) with an indication for DAPT due to recent PCI-S. Results Among the 98 patients enrolled , 48 ( 49 % ) , 31 ( 31.6 % ) , and 19 ( 19.4 % ) patients were prescribed TT , DT , and DAPT , respectively . Throughout a mean follow-up of 378 ± 15.7 days , there were no significant differences between the three regimens for all abovementioned outcomes . In particular , the total frequency of major bleeding was similar in the three groups : five cases ( 10.4 % ) in TT , one case ( 3.22 % ) in DT and no case in DAPT groups ( Chi-square test , P = 0.1987 ) . Conclusions TT , DT and DAPT displayed similar efficacy and safety . Although the superiority of OAC vs. DAPT for stroke prevention in AF patients has been demonstrated by previous r and omized trials , a smaller frequency of high thromboembolic risks ’ features in DAPT group of the present study may have prevented the observation of a higher incidence of ischemic stroke in this group BACKGROUND The effects of dual antiplatelet therapy ( DAPT ) and triple therapy ( TT : DAPT plus oral anticoagulation ) in patients with atrial fibrillation ( AF ) undergoing percutaneous coronary intervention ( PCI ) regarding to CHA2DS2-VASc score remain undefined . We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score . METHODS AND RESULTS In a prospect i ve multicenter registry , 585 patients ( 75.2 % male , 73.2 ± 8.2 years ) with AF undergoing PCI were followed up during 1 year . Of them , 157 ( 26.8 % ) had a CHA2DS2-VASc=1 , and 428 ( 73.2 % ) had a CHA2DS2-VASc ≥2 . TT was prescribed in 51.6 % with CHA2DS2-VASc=1 and in 55.5 % with CHA2DS2-VASc ≥ 2 . Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT ( 1.2 % vs. 1.3 % , P=0.73 ) , but more total ( 19.5 % vs. 6.9 % , P=0.01 ) and a tendency to more major ( 4.9 % vs. 0 % , P=0.06 ) bleeding . However , patients with CHA2DS2-VASc ≥ 2 receiving TT had a lower thromboembolism rate ( 1.7 % vs. 5.3 % , P=0.03 ) and a trend towards more bleeds ( 21.8 % vs. 15.6 % , P=0.06 ) , with an excess of major bleeding ( 8.4 % vs. 3.1 % , P=0.01 ) . Rates of major adverse cardiac events ( MACE ) in both CHA2DS2-VASc subgroups were similar , irrespective of treatment . In a Cox multivariate analysis , TT was associated to major bleeding , but not with MACE . CONCLUSIONS In patients with AF and CHA2DS2-VASc=1 undergoing PCI , the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism Objectives : To identify the therapeutic regimens used at discharge in patients receiving oral anticoagulant therapy ( OAT ) who undergo stenting percutaneous coronary intervention and stent implantation ( PCI-S )  , and to assess the safety and efficacy associated with different therapeutic regimens according to thromboembolic risk . Design : A prospect i ve multicentre registry . Setting : In hospital , after discharge and follow-up by telephone call . Patients and methods : 405 patients ( 328 male/77 female ; mean ( SD ) age 71 ( 9 ) years ) receiving OAT who underwent PCI-S between November 2003 and June 2006 from nine catheterisation laboratories of tertiary care teaching hospitals in Spain and one in the United Kingdom were included . Results : Three therapeutic regimens were identified at discharge : triple therapy (TT)—that is , any anticoagulant ( AC ) plus double antiplatelet therapy ( DAT ; 278 patients ( 68.6 % ) ; AC and a single antiplatelet ( AC+AT ; 46 ( 11.4 % ) ) and DAT only ( 81 ( 20 % ) ) . At 6 months , patients receiving TT showed the greatest rate of bleeding events . No patients receiving DAT at low thromboembolic risk presented a bleeding event ( 14.8 % receiving TT , 11.8 % receiving AC+AT and 0 % receiving DAT , p = 0.033 ) or cardiovascular event ( 6.7 % receiving TT , 0 % receiving AC+AT and 0 % receiving DAT , p = 0.126 ) . The combination of AC+AT showed the worst rate of adverse events in the whole cohort , especially in patients at moderate – high thromboembolic risk . Conclusions : In patients receiving OAT  , TT was the most commonly used regimen after PCI-S. DAT was associated with the lowest rate of bleeding events and a similar efficacy to TT in patients at low thromboembolic risk . TT should probably be restricted to patients at moderate – high thromboembolic risk BACKGROUND The optimal antithrombotic strategy for patients with atrial fibrillation ( AF ) undergoing drug-eluting stent ( DES ) implantation  is unknown . METHODS AND RESULTS The 622 consecutive AF patients undergoing DES implantation were prospect ively enrolled . Among them , 142 patients ( TT group ) continued triple antithrombotic therapy comprising aspirin , clopidogrel and warfarin after discharge ; 355 patients ( DT group ) had dual antiplatelet therapy ; 125 patients ( WS group ) were discharged with warfarin and a single antiplatelet agent . Target INR was set as 1.8 - 2.5 and was regularly monitored after discharge . The TT group had a significant reduction in stroke and major adverse cardiac and cerebral events ( MACCE ) ( 8.8 % vs 20.1 % vs 14.9 % , P=0.010 ) as compared with either the DT or WS group . In the Cox regression analysis , administration with warfarin ( hazard ratio ( HR ) 0.49 ; 95 % confidence interval ( CI ) 0.31 - 0.77 ; P=0.002 ) and baseline CHADS(2 ) score > or=2 ( HR 2.09 ; 95%CI 1.27 - 3.45 ; P=0.004 ) were independent predictors of MACCE . Importantly , the incidence of major bleeding was comparable among 3 groups ( 2.9 % vs 1.8 % vs 2.5 % , P=0.725 ) , although the overall bleeding rate was increased in the TT group . Kaplan-Meier analysis indicated that the TT group was associated with the best net clinical outcome . CONCLUSIONS The cardiovascular benefits of triple antithrombotic therapy were confirmed by reducing the MACCE rate , and its major bleeding risk might be acceptable if the INR is closely monitored Current recommendations for the antithrombotic management of patients receiving oral anticoagulation ( OAC ) who undergo percutaneous coronary intervention with stent implantation ( PCI-S ) are based on limited and relatively weak data . To broaden and strengthen available evidence , the management and 1-year outcomes of OAC patients who underwent PCI-S and were included in a prospect i ve , multicenter registry from 
    Output:
    
Conclusions For patients requiring OAC after coronary intervention , OAC plus clopidogrel may bring more clinical net benefit than TT , whereas OAC plus aspirin should be the last choice .