Decoding Bleeding Risks and Survival in Patients Undergoing Percutaneous Coronary Intervention on Antiplatelet Therapy

Abstract

This comprehensive review focuses on bleeding risk and outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy. Bleeding prevalence varies widely, ranging from 1% to 10% in clinical trials and 2.8% to 11% in real-world studies, with a significant impact on mortality. The Academic Research Consortium for High Bleeding Risk criteria are well-validated, classifying approximately 50% of patients as high bleeding risk, who subsequently experience higher post-PCI bleeding rates. Key risk factors include advanced age, chronic kidney disease, and multiple comorbidities. This review also explores bleeding event definitions, risk stratification methods, and the clinical consequences of bleeding. The strong association between bleeding and mortality after PCI underscores the importance of vigilant monitoring and tailored management strategies. (JACC Asia. 2025;5:1083-1094) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).