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In 2019, the Japanese Circulation Society published 2 guidelines in the field of coronary artery disease (CAD):(1) a guideline for acute coronary syndrome (ACS) that integrated guidelines for ST-elevation acute myocardial infarction, non-ST-elevation ACS (NSTE-ACS), and secondary prevention for myocardial infarction, and (2) guideline for revascularization of stable CAD by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). 1, 2 These guidelines were substantially revised to reflect the latest evidence, but after publication of the revised guidelines, important new evidence was reported and new concepts have been established. In particular, important evidence has accumulated about antithrombotic therapy after PCI that is directly related to daily clinical practice. Therefore, we are providing an update focusing on this area without waiting for the next revision of the entire guideline. Because the risk of bleeding events is higher and the risk of thrombotic events is lower in East Asian patients, the risk/benefit balance between thrombosis and bleeding in East Asian patients is suggested to be different from that in other populations. 3, 4 In fact, lowerdose antithrombotic therapy is recommended in East Asia compared with Western countries, and a lower target value for the international standardized ratio of prothrombin time (PT-INR) is also recommended for elderly patients. For these reasons, extrapolation of evidence from the USA and Europe requires careful consideration, and verification by assessment in clinical practice in Japan is always necessary. In this regard, the present update includes clinical trials …