Key result
Personalized bleeding-avoidance strategies minimize post-PCI bleeding complications across access, anticoagulation, and abbreviated DAPT.
Why the study?
Bleeding is a common and feared complication after PCI linked to adverse outcomes, making bleeding prevention crucial as the high bleeding risk population grows.
This review provides a comprehensive synthesis of contemporary strategies to assess and mitigate bleeding risk in patients undergoing PCI, emphasizing the importance of personalized antithrombotic management.
May guide tailored bleeding mitigation in high-risk PCI; leaves open optimal transfusion thresholds and antithrombotic regimens.
Bleeding is one of the most common and feared complications after coronary angiography and percutaneous coronary intervention (PCI). It is associated with longer hospital stays, higher mortality, and worse clinical outcomes. As the number of patients at high bleeding risk (HBR) continues to grow, preventing bleeding has become an important part of PCI management. This practical review summarizes current evidence on how to assess bleeding risk and reduce bleeding before, during, and after PCI. Several tools, including the BARC classification, ARC-HBR criteria, PRECISE-DAPT, and DAPT scores, help identify patients who may benefit from tailored treatment. Current strategies include the use of radial access, optimized anticoagulation, appropriate selection of antiplatelet therapy, newer-generation drug-eluting stents, and shorter durations of dual antiplatelet therapy in selected HBR patients. We also discuss the management of patients with atrial fibrillation requiring oral anticoagulation, as well as those with anemia or thrombocytopenia. Although significant progress has been made, several questions remain unanswered, particularly regarding transfusion thresholds, antithrombotic therapy in complex patients, and the best balance between bleeding and ischemic risks. Ongoing clinical trials are expected to provide further evidence and help improve the management of patients undergoing PCI.
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Salihu et al. (2026) conducted a review in High bleeding risk in patients undergoing percutaneous coronary intervention (PCI). Bleeding risk assessment and management strategies was evaluated. A personalized approach integrating bleeding risk stratification, radial access, optimized anticoagulation, and abbreviated DAPT regimens minimizes bleeding complications in patients undergoing PCI.
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