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Dr. Reiffel reports being an investigator and consultant for Medtronic, Janssen, Gilead, and Sanofi; a consultant for Portola, Acesion, InCardia Therapeutics; and a member of speaker’s bureaus for Janssen and Boehringer Ingelheim within the last three years. Address correspondence to: James A. Reiffel, MD, c/o 202 Birkdale Lane, Jupiter, FL 33458, USA. Email: jar2@columbia.edu. In the current issue of The Journal of Innovations in Cardiac Rhythm Management, Rusia et al. report on anticoagulation patterns in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) at two academic institutions in California between 2008 and 2016.1 Their retrospective analysis was designed to identify factors that may have influenced the appropriate use of oral anticoagulants (OACs) in this population of patients who also required antiplatelet therapy following their PCI procedure. Unfortunately, of the 4,648 patients who underwent PCI, only 211 also had AF and an indication for OAC therapy, thus making the study’s dataset quite small and therefore perhaps limiting the ability for adequate interpretation. Moreover, of the 211 patients, only 105 who met the indications for OAC treatment actually received OAC therapy after their PCI and, of these, only six received a direct-acting OAC (DOAC), with the rest receiving warfarin. Accordingly, given the limited use of DOACs, the years for which observations were made, and the differences between guidelines from this period and our more current ones regarding the combined use of OACs and antiplatelet agents in AF patients following PCI,2–5 it is possible that the current relevance of the observations could be questioned. Additionally, the report only refers to “community physicians” and provides no data as to whether the prescribing habits differed by generalists or specialists.

Oral Anticoagulant Therapy: When What Should Not Be Is and What Should Be Is Not