Percutaneous Coronary Interventions: Bleeding Risk Assessment and Management

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Bleeding is a major complication following coronary angiography and percutaneous coronary intervention (PCI).
• Increasing numbers of patients at high bleeding risk (HBR) necessitate effective bleeding prevention strategies.
• Bleeding post-PCI is linked to adverse outcomes, including prolonged hospitalization and increased mortality.

Purpose of the Study:

• To review current evidence on assessing and reducing bleeding risk in patients undergoing PCI.
• To provide practical guidance for managing bleeding risk before, during, and after PCI procedures.
• To highlight strategies for HBR patients, including those with atrial fibrillation or cytopenias.

Main Methods:

• Review of current literature and clinical guidelines on bleeding risk assessment and management in PCI.
• Discussion of validated risk stratification tools such as BARC, ARC-HBR, PRECISE-DAPT, and DAPT scores.
• Analysis of evidence-based strategies for bleeding reduction, including procedural access, anticoagulation, and antiplatelet selection.

Main Results:

• Several tools effectively identify patients at high bleeding risk.
• Strategies like radial access, optimized anticoagulation, appropriate antiplatelet selection, and newer stents can reduce bleeding.
• Specific considerations for managing patients with atrial fibrillation, anemia, or thrombocytopenia are discussed.

Conclusions:

• Significant advancements have been made in managing bleeding risk in PCI.
• Further research is needed to address remaining questions on transfusion thresholds, complex antithrombotic therapy, and the bleeding-ischemia trade-off.
• Ongoing trials aim to refine PCI management for HBR patients.