Background: Novel oral anticoagulants, also called direct oral anticoagulants, have transformed antithrombotic management in patients undergoing percutaneous coronary intervention, especially those with atrial fibrillation requiring long-term anticoagulation.

Objective: To evaluate the role, safety, and clinical effectiveness of NOAC-based antithrombotic strategies in patients undergoing coronary intervention.

Methods: This review-style research article summarizes contemporary evidence regarding apixaban, rivaroxaban, dabigatran, and edoxaban in PCI patients, with emphasis on bleeding, ischemic events, stent thrombosis, and optimal therapy duration.

Results: NOAC-based dual therapy, generally consisting of a NOAC plus a P2Y12 inhibitor, reduces bleeding compared with traditional warfarin-based triple therapy. Ischemic outcomes are broadly comparable in selected patients, although early aspirin use may be considered in patients with high thrombotic risk.

Conclusion: NOACs have become central to antithrombotic strategies after PCI in patients requiring long-term anticoagulation. Individualized balancing of bleeding and ischemic risk is essential.