Bleeding complications in patients undergoing percutaneous coronary interventions: Current status and perspective

Bleeding complications are among the most common complications of percutaneous coronary intervention (PCI) procedures. A multitude of studies carried out over the last decade have confirmed that bleeding complications after PCI have a negative impact on patients' outcome (dissatisfaction, morbidity, and mortality) and hospital indices (length of stay and costs). Apart from better recognition and classification of bleeding, recent research has helped to device several risk stratification tools that have markedly improved prediction of peri-PCI bleeding. Moreover, parallel with the recognition of the deleterious effects of peri-PCI bleeding, several strategies (pre-PCI risk stratification for bleeding, the use of bivalirudin as an antithrombotic/ anticoagulant strategy, the radial artery route for vascular access and vascular closure devices) that aim to reduce peri-PCI bleeding were developed and used. Their application has markedly reduced the incidence of bleeding and improved the clinical outcome. In this review, we focus primarily on the bleeding complications occurring during PCI procedures. Specifically, we summarize recent research on the need for a consensus in bleeding definition, incidence of bleeding events, and their impact on outcome, factors associated with increased risk and risk stratification for bleeding, putative mechanisms through which bleeding impact on outcome, and bleeding-avoidance strategies to be used in the setting of PCI procedures.