Patients with atrial fibrillation undergoing percutaneous coronary intervention require careful antithrombotic therapy to prevent both cardioembolic stroke and coronary ischemic events. However, combining oral anticoagulation with antiplatelet therapy increases bleeding risk. Contemporary management favors short-duration triple therapy followed by dual therapy using an oral anticoagulant plus a P2Y12 inhibitor, usually clopidogrel. Direct oral anticoagulants are generally preferred over vitamin K antagonists in eligible patients. This article reviews risk stratification, drug selection, treatment duration, and practical clinical strategies for balancing ischemic and bleeding risks in atrial fibrillation patients undergoing PCI.