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Introduction Triple antithrombotic therapy (TAT), consisting of an oral anticoagulant and dual antiplatelet therapy (DAPT), has been introduced as a crucial role in preventing ischemic events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) (1). For these patients, the standard strategy includes an initial short-term triple therapy consisting of oral anticoagulation, aspirin, and a P2Y12 inhibitor. This is followed by dual treatment with an oral anticoagulant and a P2Y12 inhibitor. Beyond one year after PCI, long-term management typically involves oral anticoagulant monotherapy (2). However, some studies have demonstrated that continuing TAT for more than one week has not been associated with improved clinical outcomes (3). This study aims to evaluate the clinical outcomes of long-term TAT in these patients.Methods A retrospective observational study was conducted on patients diagnosed with atrial fibrillation (AF) or atrial flutter who underwent percutaneous coronary intervention (PCI) in Queen Elizabeth Hospital, Birmingham, and received triple antithrombotic therapy (TAT) in 2022 and 2023. Patients receiving TAT for indications other than AF/flutter were excluded, including those with a history of deep vein thrombosis (DVT), pulmonary embolism, intracardiac thrombus (left atrium/left ventricle), heavy thrombus burden, or nephrotic syndrome. The study evaluated major and clinically relevant non-major bleeding events and major adverse cardiac and cerebrovascular events (MACCE) over a follow-up period of 12 months post-procedure. Additionally, major bleeding events, hospital readmissions, and other significant complications were recorded and analyzed.Results Of the 1432 patients who underwent PCI in these two years, 109 were treated with TAT for one year after PCI due to AF (N=63)//Flutter (N=5). However, 31 patients were excluded. Among the 78 included patients, the sample population consisted of 61 males (79.22%) and 16 females (20.78%). The duration of Triple Antithrombotic Therapy (ATT) varied among patients, with 32 patients (41.03%) receiving it for 1 week and 42 patients (53.85%) for 4 weeks. Antithrombotic Therapy (ATT) varied among patients, with 32 patients (41.03%) receiving it for 1 week, 42 patients (53.85%) for 4 weeks, two patients (2.56%) for 12 weeks, and two patients (2.56%) for 2 days. Among all these patients, nine patients (10 events) experienced MACCE during the one subsequent year after PCI (6 deaths, 2 NSTEMI, 1 STEMI, and one CVA due to subarachnoid hemorrhage. The incidence of MACCE was 12.5% (4/32) in patients receiving TAT for 1 week and 11.9% (5/42) in patients receiving TAT for 4 weeks, with a risk ratio (RR) of 1.05 (95% CI: 0.31–3.60, p = 1.00). No significant difference was seen among different groups of patients regarding severe or non-severe adverse outcomes and complications.Conclusion Although differences in clinical outcomes and various rates of adverse events have been reported in patients with different TAT treatment durations due to AF/flutter after PCI, this study did not show any statistically significant difference in 1-year clinical outcomes and adverse events. This result underscores the need for more comprehensive controlled trials regarding evaluating the pros and cons of each therapeutic strategy in these patients.