Implications of bleeding and blood transfusion in percutaneous coronary intervention.

For patients undergoing percutaneous coronary intervention (PCI), bleeding complications are a major clinical concern. With advances in pharmacotherapy and devices over the past 2 decades, the risk of ischemic outcomes, such as myocardial infarction or death, has decreased. Bleeding complications have more recently become a clinical and research priority. Determining the incidence of and risk factors for bleeding is complicated by the multiple systems used to classify bleeding severity and report bleeding events. The origin of the data, clinical trials versus registries, also influences the incidence of reported bleeding events. Registry data suggest that risk of bleeding among patients undergoing PCI is higher in clinical practice than the incidence observed in clinical trials. Another clinical concern is the possible association between PCI-related bleeding complications and myocardial infarction, stroke, or death. Reduction in bleeding risk is a desirable goal that may potentially improve survival and increase comfort for patients undergoing PCI. Using strategies such as careful vascular access, alternative radial artery access, and modified antithrombotic regimen may reduce bleeding during PCI as well as improve patient outcomes.