Abstract: OBJECTIVE To study the antithrombotic strategy of atrial fibrillation(AF) combine with acute coronary syndrome (ACS). METHODS One male patient of atrial fibrillation combine with coronary heart disease (CHD) at age of 46 was at a low risk of stroke. Anticoagulant was not given, but stroke happened. By referring to some of the guidelines and literature, analyzed the different antithrombotic strategies and their advantages and disadvantages in patients with acute coronary syndrome with CHA2DS2-VASc score of 1. RESULTS The literature suggests that patients of 1 score of CHA₂DS₂-VASc with low risk of bleeding should be given anticoagulant. Warfarin + clopidogrel could effectively reduce the risk of bleeding in patients with antithrombotic. Therefore, dual antiplatelet therapy should be adjusted to triple clopidogrel in 1-3 months according to the specific circumstances of patient as soon as possible. CONCLUSION Bleeding and thrombosis shall be fully concerned, and of individual antithrombotic therapy strategy will be developed accordingly.