Long-term oral anticoagulation (OAC) is the cornerstone in the treatment of patients with atrial fibrillation (AF) at moderate to high risk of stroke, those with prosthetic heart valves, cardiogenic thromboembolism, recent deep vein thrombosis or pulmonary embolism. Approximately 70–80% of all patients in AF have an indication for continuous OAC, and coronary artery disease coexists in 20–30% of these patients^1,2. Balancing the risk of bleeding and thromboembolism is crucial in the management of patients on OAC, and this is never more apparent than when such patients require percutaneous coronary intervention (PCI). The periprocedural management of anticoagulated patients is very important, but clinical practice varies widely between clinicians, hospitals, and countries, driven by a lack of data on which to draw guidance. Furthermore as the number of available oral antiplatelet and anticoagulant agents continue to grow, so does the uncertainty regarding optimal combination therapy in this growing pool of the patients with overlapping clinical indications. Given the high proportion of patients with atherothrombosis and requiring OAC for conditions particularly like AF, it is important that physicians are aware of the clinical implications and management of these overlapping syndromes.