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).
• Patients at high bleeding risk (HBR) are increasing, necessitating effective bleeding prevention strategies.
• Bleeding complications are linked to adverse clinical outcomes, including longer hospital stays and higher mortality.

Purpose of the Study:

• To review current evidence on assessing and reducing bleeding risk in patients undergoing PCI.
• To summarize strategies for managing bleeding risk before, during, and after PCI.
• To highlight areas requiring further research in HBR patients undergoing PCI.

Main Methods:

• Review of current literature and clinical trial evidence 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 contemporary strategies for bleeding reduction, including procedural and pharmacologic approaches.

Main Results:

• Several tools effectively identify patients at high bleeding risk (HBR).
• Strategies like radial access, optimized anticoagulation, appropriate antiplatelet selection, drug-eluting stents, and de-escalated dual antiplatelet therapy can reduce bleeding.
• Management of specific patient groups (e.g., atrial fibrillation, anemia, thrombocytopenia) requires tailored approaches.

Conclusions:

• Significant advancements have been made in managing bleeding risk in PCI patients.
• Further research is needed to address optimal transfusion strategies, antithrombotic therapy in complex cases, and the bleeding-ischemic risk balance.
• Ongoing trials aim to refine PCI management for HBR patients.