Afib, CVD, and a bloody butt

What's worse than bleeding relentlessly out of your butt because you're on oral anticoagulation for your afib and antiplatelet therapy for your cardiovascular disease? An intracranial hemorrhage for the same reason! But the times they are a changin'. Today we follow a personal journey of bleeding by Dr. Sam's dad. And then we review 4 RCTs that prove it never should have happened.OAC-ALONE Study Investigators. Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation. Circulation. 2019 Jan 29;139(5):604-616. AFIRE Investigators. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med. 2019 Sep 19;381(12):1103-1113.EPIC-CAD Investigators. Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease. N Engl J Med. 2024 Dec 5;391(22):2075-2086. AQUATIC Trial Investigators. Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation. N Engl J Med. 2025 Oct 23;393(16):1578-1588.