---
title: "Dual antithrombotic therapy with potent antiplatelet inhibitors in AF and ACS — randomized trial"
id: "nature-0-dual-antithrombotic-therapy-using-potent-antiplatelet-inhibitors-in-atrial"
canonical_url: "https://medichelpline.com/clinical-feed/nature-0-dual-antithrombotic-therapy-using-potent-antiplatelet-inhibitors-in-atrial"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "Nature Medicine"
source_url: "https://www.nature.com/articles/s41591-026-04629-7"
published_at: "2026-08-29T11:39:07.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Dual antithrombotic therapy with potent antiplatelet inhibitors in AF and ACS — randomized trial
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/nature-0-dual-antithrombotic-therapy-using-potent-antiplatelet-inhibitors-in-atrial
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** Nature Medicine
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41591-026-04629-7)
- **Published At:** 2026-08-29T11:39:07.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The article reports a randomized controlled trial titled “Dual antithrombotic therapy using potent antiplatelet inhibitors in atrial fibrillation and acute coronary syndrome.” - The study was published in Nature Medicine on 29 August 2026 and lists many contributing authors. - The article frames the clinical problem: choosing an optimal antithrombotic regimen for patients with **atrial fibrillation (AF)** who also present with **acute coronary syndrome (ACS)** is challenging. - Existing randomized trials previously showed that **dual antithrombotic therapy (DAT)** — a **direct oral anticoagulant (DOAC)** plus a **P2Y12 inhibitor** — reduces **bleeding** compared with traditional **triple therapy** that included **vitamin K antagonists (VKAs)**. - Subsequent meta-analyses cited in the article have raised concern that DAT may be associated with a higher rate of **ischemic events** in some settings. - The provided source text contains only the article metadata and the opening of the Abstract; the remainder of the Abstract, full methods, results, and conclusions were not included in the supplied text and therefore are not reported here. - Where trial design, participant numbers, specific interventions, endpoints, statistical findings, safety outcomes, and authors' conclusions would normally appear, those details were not reported in the source text provided. - Readers are advised to consult the full Nature Medicine article or the PDF linked in the source for complete trial methods, outcome data, and authors' interpretation.
## Clinical Analysis & Structured Key Points
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[nature](https://www.nature.com/) 2. [nature medicine](https://www.nature.com/nm) 3. [articles](https://www.nature.com/nm/articles?type=article) 4. article Dual antithrombotic therapy using potent antiplatelet inhibitors in atrial fibrillation and acute coronary syndrome: a randomized controlled trial [ Download PDF ](https://www.nature.com/articles/s41591-026-04629-7.pdf) [ Download PDF ](https://www.nature.com/articles/s41591-026-04629-7.pdf) * Article * [Open access](https://www.springernature.com/gp/open-science/about/the-fundamentals-of-open-access-and-open-research) * Published: 29 August 2026 # Dual antithrombotic therapy using potent antiplatelet inhibitors in atrial fibrillation and acute coronary syndrome: a randomized controlled trial * [Konstantinos D. Rizas](https://www.nature.com/articles/s41591-026-04629-7#auth-Konstantinos_D_-Rizas-Aff1-Aff2-Aff3) [ORCID: orcid.org/0000-0002-5993-0339](https://orcid.org/0000-0002-5993-0339)[1](https://www.nature.com/articles/s41591-026-04629-7#Aff1),[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Konstantinos Mourouzis](https://www.nature.com/articles/s41591-026-04629-7#auth-Konstantinos-Mourouzis-Aff2-Aff3) [ORCID: orcid.org/0000-0001-8702-7369](https://orcid.org/0000-0001-8702-7369)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Dominik Rath](https://www.nature.com/articles/s41591-026-04629-7#auth-Dominik-Rath-Aff4)[4](https://www.nature.com/articles/s41591-026-04629-7#Aff4), * [Christoph B. Olivier](https://www.nature.com/articles/s41591-026-04629-7#auth-Christoph_B_-Olivier-Aff5)[5](https://www.nature.com/articles/s41591-026-04629-7#Aff5), * [Laura Elisa Villegas Sierra](https://www.nature.com/articles/s41591-026-04629-7#auth-Laura_Elisa-Villegas_Sierra-Aff2-Aff3)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Theofanis Korovesis](https://www.nature.com/articles/s41591-026-04629-7#auth-Theofanis-Korovesis-Aff2-Aff3)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Amin Polzin](https://www.nature.com/articles/s41591-026-04629-7#auth-Amin-Polzin-Aff6)[6](https://www.nature.com/articles/s41591-026-04629-7#Aff6), * [Amani Al Tawil](https://www.nature.com/articles/s41591-026-04629-7#auth-Amani_Al-Tawil-Aff7)[7](https://www.nature.com/articles/s41591-026-04629-7#Aff7), * [Reza Wakili](https://www.nature.com/articles/s41591-026-04629-7#auth-Reza-Wakili-Aff8-Aff9)[8](https://www.nature.com/articles/s41591-026-04629-7#Aff8),[9](https://www.nature.com/articles/s41591-026-04629-7#Aff9), * [Lukas von Stuelpnagel](https://www.nature.com/articles/s41591-026-04629-7#auth-Lukas-Stuelpnagel-Aff2-Aff3) [ORCID: orcid.org/0000-0003-2238-2815](https://orcid.org/0000-0003-2238-2815)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Katharina Mayer](https://www.nature.com/articles/s41591-026-04629-7#auth-Katharina-Mayer-Aff10-Aff11)[10](https://www.nature.com/articles/s41591-026-04629-7#Aff10),[11](https://www.nature.com/articles/s41591-026-04629-7#Aff11), * [Marion Janisch](https://www.nature.com/articles/s41591-026-04629-7#auth-Marion-Janisch-Aff11) [ORCID: orcid.org/0009-0008-4707-1363](https://orcid.org/0009-0008-4707-1363)[11](https://www.nature.com/articles/s41591-026-04629-7#Aff11), * [Tanja Ulrich](https://www.nature.com/articles/s41591-026-04629-7#auth-Tanja-Ulrich-Aff11)[11](https://www.nature.com/articles/s41591-026-04629-7#Aff11), * [Sarah Lang](https://www.nature.com/articles/s41591-026-04629-7#auth-Sarah-Lang-Aff11) [ORCID: orcid.org/0009-0001-1780-9485](https://orcid.org/0009-0001-1780-9485)[11](https://www.nature.com/articles/s41591-026-04629-7#Aff11), * [Sebastian K. G. Maier](https://www.nature.com/articles/s41591-026-04629-7#auth-Sebastian_K__G_-Maier-Aff12) [ORCID: orcid.org/0000-0002-1485-8345](https://orcid.org/0000-0002-1485-8345)[12](https://www.nature.com/articles/s41591-026-04629-7#Aff12), * [Florian Brattinger](https://www.nature.com/articles/s41591-026-04629-7#auth-Florian-Brattinger-Aff12)[12](https://www.nature.com/articles/s41591-026-04629-7#Aff12), * [Lorenz Bott-Flügel](https://www.nature.com/articles/s41591-026-04629-7#auth-Lorenz-Bott_Fl_gel-Aff13) [ORCID: orcid.org/0000-0003-0932-1241](https://orcid.org/0000-0003-0932-1241)[13](https://www.nature.com/articles/s41591-026-04629-7#Aff13), * [Harilaos Bogossian](https://www.nature.com/articles/s41591-026-04629-7#auth-Harilaos-Bogossian-Aff14-Aff15)[14](https://www.nature.com/articles/s41591-026-04629-7#Aff14),[15](https://www.nature.com/articles/s41591-026-04629-7#Aff15), * [Konstantinos Iliodromitis](https://www.nature.com/articles/s41591-026-04629-7#auth-Konstantinos-Iliodromitis-Aff14-Aff15)[14](https://www.nature.com/articles/s41591-026-04629-7#Aff14),[15](https://www.nature.com/articles/s41591-026-04629-7#Aff15), * [Luisa Freyer](https://www.nature.com/articles/s41591-026-04629-7#auth-Luisa-Freyer-Aff2-Aff3)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Julius Steffen](https://www.nature.com/articles/s41591-026-04629-7#auth-Julius-Steffen-Aff2-Aff3)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Konstantin Stark](https://www.nature.com/articles/s41591-026-04629-7#auth-Konstantin-Stark-Aff2-Aff3) [ORCID: orcid.org/0000-0002-5369-8399](https://orcid.org/0000-0002-5369-8399)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Elodie Eiffener](https://www.nature.com/articles/s41591-026-04629-7#auth-Elodie-Eiffener-Aff16) [ORCID: orcid.org/0000-0001-5971-4903](https://orcid.org/0000-0001-5971-4903)[16](https://www.nature.com/articles/s41591-026-04629-7#Aff16), * [Lauren E. Sams](https://www.nature.com/articles/s41591-026-04629-7#auth-Lauren_E_-Sams-Aff2-Aff3)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Tobias Petzold](https://www.nature.com/articles/s41591-026-04629-7#auth-Tobias-Petzold-Aff17-Aff18) [ORCID: orcid.org/0000-0001-7805-5632](https://orcid.org/0000-0001-7805-5632)[17](https://www.nature.com/articles/s41591-026-04629-7#Aff17),[18](https://www.nature.com/articles/s41591-026-04629-7#Aff18), * [Axel Linke](https://www.nature.com/articles/s41591-026-04629-7#auth-Axel-Linke-Aff19)[19](https://www.nature.com/articles/s41591-026-04629-7#Aff19), * [Felix M. Heidrich](https://www.nature.com/articles/s41591-026-04629-7#auth-Felix_M_-Heidrich-Aff19)[19](https://www.nature.com/articles/s41591-026-04629-7#Aff19), * [Samuel Sossala](https://www.nature.com/articles/s41591-026-04629-7#auth-Samuel-Sossala-Aff20-Aff21) [ORCID: orcid.org/0000-0001-8034-2673](https://orcid.org/0000-0001-8034-2673)[20](https://www.nature.com/articles/s41591-026-04629-7#Aff20),[21](https://www.nature.com/articles/s41591-026-04629-7#Aff21), * [Saif Zako](https://www.nature.com/articles/s41591-026-04629-7#auth-Saif-Zako-Aff6)[6](https://www.nature.com/articles/s41591-026-04629-7#Aff6), * [Nikolaos Dagkonakis](https://www.nature.com/articles/s41591-026-04629-7#auth-Nikolaos-Dagkonakis-Aff22)[22](https://www.nature.com/articles/s41591-026-04629-7#Aff22), * [Andreas Schäfer](https://www.nature.com/articles/s41591-026-04629-7#auth-Andreas-Sch_fer-Aff23) [ORCID: orcid.org/0000-0003-3206-6162](https://orcid.org/0000-0003-3206-6162)[23](https://www.nature.com/articles/s41591-026-04629-7#Aff23), * [Frank Edelmann](https://www.nature.com/articles/s41591-026-04629-7#auth-Frank-Edelmann-Aff24-Aff25)[24](https://www.nature.com/articles/s41591-026-04629-7#Aff24),[25](https://www.nature.com/articles/s41591-026-04629-7#Aff25), * [David M. 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Maeder](https://www.nature.com/articles/s41591-026-04629-7#auth-Micha_T_-Maeder-Aff1)[1](https://www.nature.com/articles/s41591-026-04629-7#Aff1), * [Meinrad Gawaz](https://www.nature.com/articles/s41591-026-04629-7#auth-Meinrad-Gawaz-Aff4) [ORCID: orcid.org/0000-0003-1124-9592](https://orcid.org/0000-0003-1124-9592)[4](https://www.nature.com/articles/s41591-026-04629-7#Aff4), * [Hans-Josef Feistritzer](https://www.nature.com/articles/s41591-026-04629-7#auth-Hans_Josef-Feistritzer-Aff32)[32](https://www.nature.com/articles/s41591-026-04629-7#Aff32), * [Norbert Frey](https://www.nature.com/articles/s41591-026-04629-7#auth-Norbert-Frey-Aff33) [ORCID: orcid.org/0000-0001-7611-378X](https://orcid.org/0000-0001-7611-378X)[33](https://www.nature.com/articles/s41591-026-04629-7#Aff33), * [Stefan Kääb](https://www.nature.com/articles/s41591-026-04629-7#auth-Stefan-K__b-Aff2-Aff3) [ORCID: orcid.org/0000-0001-8824-3581](https://orcid.org/0000-0001-8824-3581)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3), * [Riza Sahin](https://www.nature.com/articles/s41591-026-04629-7#auth-Riza-Sahin-Aff34)[34](https://www.nature.com/articles/s41591-026-04629-7#Aff34), * [Matthias Pauschinger](https://www.nature.com/articles/s41591-026-04629-7#auth-Matthias-Pauschinger-Aff34)[34](https://www.nature.com/articles/s41591-026-04629-7#Aff34), * [Thomas Stiermaier](https://www.nature.com/articles/s41591-026-04629-7#auth-Thomas-Stiermaier-Aff35-Aff36) [ORCID: orcid.org/0000-0003-1957-3741](https://orcid.org/0000-0003-1957-3741)[35](https://www.nature.com/articles/s41591-026-04629-7#Aff35),[36](https://www.nature.com/articles/s41591-026-04629-7#Aff36), * [Ingo Eitel](https://www.nature.com/articles/s41591-026-04629-7#auth-Ingo-Eitel-Aff35-Aff36)[35](https://www.nature.com/articles/s41591-026-04629-7#Aff35),[36](https://www.nature.com/articles/s41591-026-04629-7#Aff36), * [Marc Kollum](https://www.nature.com/articles/s41591-026-04629-7#auth-Marc-Kollum-Aff37)[37](https://www.nature.com/articles/s41591-026-04629-7#Aff37), * [Jan Sebastian Wolter](https://www.nature.com/articles/s41591-026-04629-7#auth-Jan_Sebastian-Wolter-Aff20-Aff21)[20](https://www.nature.com/articles/s41591-026-04629-7#Aff20),[21](https://www.nature.com/articles/s41591-026-04629-7#Aff21), * [Michael Schreinlechner](https://www.nature.com/articles/s41591-026-04629-7#auth-Michael-Schreinlechner-Aff38)[38](https://www.nature.com/articles/s41591-026-04629-7#Aff38), * [Axel Bauer](https://www.nature.com/articles/s41591-026-04629-7#auth-Axel-Bauer-Aff38) [ORCID: orcid.org/0000-0001-9201-8555](https://orcid.org/0000-0001-9201-8555)[38](https://www.nature.com/articles/s41591-026-04629-7#Aff38), * [Christoph Stellbrink](https://www.nature.com/articles/s41591-026-04629-7#auth-Christoph-Stellbrink-Aff39)[39](https://www.nature.com/articles/s41591-026-04629-7#Aff39), * [Ulf Landmesser](https://www.nature.com/articles/s41591-026-04629-7#auth-Ulf-Landmesser-Aff17) [ORCID: orcid.org/0000-0002-0214-3203](https://orcid.org/0000-0002-0214-3203)[17](https://www.nature.com/articles/s41591-026-04629-7#Aff17), * [Paulus Kirchhof](https://www.nature.com/articles/s41591-026-04629-7#auth-Paulus-Kirchhof-Aff40-Aff41-Aff42)[40](https://www.nature.com/articles/s41591-026-04629-7#Aff40),[41](https://www.nature.com/articles/s41591-026-04629-7#Aff41),[42](https://www.nature.com/articles/s41591-026-04629-7#Aff42), * [Dirk Sibbing](https://www.nature.com/articles/s41591-026-04629-7#auth-Dirk-Sibbing-Aff2-Aff3-Aff43)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3),[43](https://www.nature.com/articles/s41591-026-04629-7#Aff43), * [Holger Thiele](https://www.nature.com/articles/s41591-026-04629-7#auth-Holger-Thiele-Aff32) [ORCID: orcid.org/0000-0002-0169-998X](https://orcid.org/0000-0002-0169-998X)[32](https://www.nature.com/articles/s41591-026-04629-7#Aff32), * [Adnan Kastrati](https://www.nature.com/articles/s41591-026-04629-7#auth-Adnan-Kastrati-Aff10-Aff11) [ORCID: orcid.org/0000-0003-4341-891X](https://orcid.org/0000-0003-4341-891X)[10](https://www.nature.com/articles/s41591-026-04629-7#Aff10),[11](https://www.nature.com/articles/s41591-026-04629-7#Aff11), * [Ulrich Mansmann](https://www.nature.com/articles/s41591-026-04629-7#auth-Ulrich-Mansmann-Aff7) [ORCID: orcid.org/0000-0002-9955-8906](https://orcid.org/0000-0002-9955-8906)[7](https://www.nature.com/articles/s41591-026-04629-7#Aff7) & * … * [Steffen Massberg](https://www.nature.com/articles/s41591-026-04629-7#auth-Steffen-Massberg-Aff2-Aff3) [ORCID: orcid.org/0000-0001-7387-3986](https://orcid.org/0000-0001-7387-3986)[2](https://www.nature.com/articles/s41591-026-04629-7#Aff2),[3](https://www.nature.com/articles/s41591-026-04629-7#Aff3) Show authors [_Nature Medicine_](https://www.nature.com/nm) (2026) [Cite this article](https://www.nature.com/articles/s41591-026-04629-7#citeas) [ Save article ](https://www.nature.com/articles/s41591-026-04629-7/save-research?_csrf=5i7wAek6M1Xwi_UYFK6bJNm2EfUmDNWF) [ View saved research ](https://www.nature.com/saved-research) ## Abstract The selection of the optimal antithrombotic regimen in patients with atrial fibrillation and acute coronary syndrome remains challenging. Previous trials have demonstrated that dual antithrombotic therapy (DAT), consisting of direct oral anticoagulants (DOACs) plus a P2Y12 inhibitor, reduces bleeding compared to a triple-therapy regimen using vitamin K antagonists. However, subsequent meta-analyses have suggested an increased risk of ischemic events with DAT, particularly within
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