Abstract： Objective： To observe the clinical efficacy of Shexiang Baoxin Pills （SXBX） combined with Rivaroxaban and Clopidogrel in the treatment of coronary heart disease complicated by atrial fibrillation after percutaneous coronary intervention. Methods： Patients with coronary heart disease complicated by atrial fibrillation after percutaneous coronary intervention admitted to Deqing County People's Hospital from June 2022 to June 2025 were enrolled. After risk stratification screening， a total of 80 patients were included and randomly divided into a control group and an SXBX group using a random number table method， with 40 cases in each group. The control group received Rivaroxaban and Clopidogrel，while the SXBX group received Shexiang Baoxin Pills in addition to Rivaroxaban and Clopidogrel. Both groups were treated continuously for 12 weeks. Clinical efficacy was compared between the two groups. Echocardiographic parameters [mitral orifice peak blood flow velocity （E/A）， cardiac output （CO）， tissue Doppler peak velocity of the posterior mitral valve leaflet （e'/a'）]，coagulation and fibrinolysis indicators [prothrombin time （PT），activated partial thromboplastin time （APTT），fibrinogen （Fib）]，myocardial injury markers [N-terminal pro-brain natriuretic peptide （NT-proBNP）， high-sensitivity cardiac troponin T （hs-cTnT）]， major adverse cardiovascular and cerebrovascular events （MACCE） and serious bleeding events （all-cause death， nonfatal myocardial infarction， ischemic/hemorrhagic stroke， coronary revascularization， intracranial hemorrhage， major gastrointestinal bleeding）， and adverse reactions （gastrointestinal discomfort， gingival bleeding， ecchymosis， mild respiratory distress） were assessed before and after treatment. Results： After treatment， the total effective rate was 87.50% （35/40） in the SXBX group，significantly higher than that of 65.00% （26/40） in the control group （P＜0.05）. E/A and e'/a' levels decreased in both groups after treatment （P＜0.05），with significantly lower levels in the SXBX group （P＜0.05）；CO levels increased in both groups，with significantly higher levels in the SXBX group （P＜0.05）. PT and APTT values increased in both groups after treatment （P＜0.05），with significantly higher values in the SXBX group（ P＜0.05）；Fib levels decreased in the SXBX group after treatment and were significantly lower than those in the control group （P＜0.05），while no significant change in Fib was observed in the control group （P＞0.05）. NT-proBNP and hs-cTnT levels decreased in both groups after treatment （P＜0.05）， with significantly lower levels in the SXBX group （P＜0.05）. Within six months of treatment，the incidence of MACCE and serious bleeding events was 7.50% （3/ 40） in the SXBX group and 15.00% （6/40） in the control group，with no significant difference between groups （P＞ 0.05）. During treatment，the incidence of adverse reactions was 22.50%（ 9/40） in the SXBX group and 10.00%（ 4/40） in the control group， with no significant difference between groups （P＞0.05）. Conclusion： SXBX combined with Rivaroxaban and Clopidogrel shows good efficacy in patients with coronary heart disease complicated by atrial fibrillation after percutaneous coronary intervention， and can improve left ventricular diastolic function， coagulation-fibrinolysis function，and attenuate myocardial injury.