Abstract Aims This study evaluated the feasibility of the intermittent use of direct oral anticoagulants (DOACs) guided by continuous rhythm monitoring via a clinically validated wearable smart device in high-bleeding risk (HBR) patients with symptomatic paroxysmal atrial fibrillation (AF) otherwise subjected to chronic anticoagulation after percutaneous coronary intervention (PCI). Methods and results The INTERMITTENT registry was a 3-year prospective observational study at 8 Italian centers. Inclusion criteria were elective or urgent PCI, Academic Research Consortium HBR criteria, history of symptomatic 12-lead ECG detected paroxysmal AF episodes, indication to DOACs, and use of a wearable smart device (Apple WatchTM). Thirty days after PCI, patients free of AF episodes discontinued DOAC. However, if an AF episode lasting>6 minutes or a total AF burden>6 hours over 24 hours was detected, DOAC was initiated for 30 consecutive days, and withdrawn afterwards if no further AF episodes occurred. At the discretion of the referring physician, intermittent anticoagulation was offered to 89 patients, whereas continuous treatment with DOACs was prescribed to 151 patients. During a follow-up of 298+87 days, the average duration of oral anticoagulation was significantly shorter in the intermittent anticoagulation group (176+43 days, p=0.0001), representing a 40% reduction in anticoagulation time compared to the continuous group. Ischemic and bleeding end-points were not significantly different between the two groups. Propensity score-matching resulted in a total of 69 matched patients with intermittent versus continuous anticoagulation, respectively. During a follow-up of 291+63 days, there was a significant 46% reduction in anticoagulation time in the intermittent compared to the continuous group (p=0.0001). Conclusion In high-bleeding risk patients with a history of paroxysmal AF episodes who underwent PCI, intermittent anticoagulation guided by continuous rhythm monitoring with a wearable device was feasible and decreased significantly the duration of anticoagulation.