To explore the efficacy and safety of rivaroxaban in the antithrombotic treatment of patients with coronary heart disease and atrial fibrillation after percutaneous coronary intervention is the objective of the study. A total of 124 patients with coronary heart disease and atrial fibrillation admitted and undergoing percutaneous coronary intervention in our hospital from August 2019 to August 2021 were selected and randomly divided into an experimental group and a control group, with 62 cases in each group. After the operation, both groups were treated with triple antithrombotic therapy for 6 mo, then switched to dual antithrombotic therapy for six more months, in which the experimental group was treated with rivaroxaban and the control group was treated with warfarin. The coagulation function of the two groups of patients before and after percutaneous coronary intervention was compared and the occurrence of thromboembolic events and bleeding events were observed at the same time. Compared with the situation before treatment, the activated partial thromboplastin time and prothrombin time in the two groups were significantly increased after treatment, with statistically significant differences (p<0.05); compared with the experimental group, the increase of activated partial thromboplastin time and prothrombin time in the control group was more significant (p<0.05). There was no significant difference in the incidence of thromboembolic events between the two groups (p>0.05). The incidence of bleeding events in the experimental group was significantly lower than that in the control group and the difference was statistically significant (p<0.05). Compared with warfarin, rivaroxaban had comparable efficacy, but a lower bleeding incidence and a safer effect in the antithrombotic treatment of patients with coronary heart disease and atrial fibrillation after percutaneous coronary intervention.