Abstract Background The strategy of antithrombotic therapy in patients with atrial fibrillation (AF) after revascularization with drug-eluting stents continues to be debated. The evidence in elderly population in this scenario is particularly scarce. Purpose We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with AF after revascularization with drug-eluting stents. Methods Retrospective registry in 20 centers including consecutive patients over 75 years with AF treated with drug-eluting stents. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months. Results Out of 41,000 patients undergoing PCI 1,249 patients (81.1±4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p=0.04) but less MACCE (8.7% vs. 13.6%, p=0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p=0.03) and similar MACCE (9.8% vs. 9.4%, p=0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates. Conclusions Despite advanced age TAT prevails, but prolonged durations or use of VKA are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bristol-Myers-Squibb/Pfizer