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Background  Management of antithrombotic agents after implantable cardioverter defibrillator implantation is challenging, particularly among patients with atrial fibrillation and coronary artery disease.    Methods and Results  Using data from National Cardiovascular Data Registry ®  Implantable Cardioverter Defibrillator Registry ™  linked with Medicare claims data, we identified 25 180 patients with atrial fibrillation and coronary artery disease who underwent implantable cardioverter defibrillator implantation. Patients were categorized into 5 different groups according to antithrombotic agents prescribed at discharge (any 1 antiplatelet agent [A, n=6538], dual antiplatelet therapy [ DA , n=3414], warfarin [n=5264], warfarin+A [n=7994], warfarin+ DA  [n=1970]). We assessed the primary outcomes occurring within 30 days of hospital discharge. Combinations of  DA  (adjusted hazard ratio [ HR ]: 1.39; 95%  CI : 1.03 to 1.87), warfarin+A (adjusted  HR : 1.32; 95%  CI : 1.03 to 1.69), and warfarin+ DA  (adjusted  HR : 2.03; 95%  CI : 1.49 to 2.77) were associated with a higher bleeding risk. The risk of major adverse cardiovascular events was higher in patients discharged with A (adjusted  HR : 1.69; 95%  CI : 1.33 to 2.16),  DA  (adjusted  HR : 2.17; 95%  CI : 1.66 to 2.83), and  DA +warfarin (adjusted  HR : 1.61; 1.16 to 2.24). There was no association between postdischarge antithrombotic agents and thromboembolic events or device‐related complications.    Conclusions  Short‐term bleeding risk and major adverse cardiovascular events differ with usage patterns of antithrombotic agents, while the risk of thromboembolic events and device‐related complications is relatively constant. These data may help clinicians balance risks and benefits when choosing antithrombotic therapy following implantable cardioverter defibrillator implantation.

journal of the american heart association

Antithrombotic Therapy and Outcomes After  ICD  Implantation in Patients With Atrial Fibrillation and Coronary Artery Disease: An Analysis From the National Cardiovascular Data Registry ( NCDR ) ®