Advances in anti-thrombotic and anti-platelet therapies have improved outcomes in patients undergoing percutaneous coronary interventions (PCIs) through a reduction in ischaemic events, at the expense of peri-procedural bleeding complications. These may occur through either the access site through which the PCI was performed or through non-access-related sites. There are currently over 10 definitions of major bleeding events consisting of clinical events, changes in laboratory parameters and clinical outcomes, where different definitions will differentially influence the reported incidence of major bleeding events. Use of different major bleeding definitions has been shown to change the reported outcome of a number of therapeutic strategies in randomised controlled trials but as yet a universal bleeding definition has not gained widespread adoption in assessing the efficacy of such therapeutic interventions. Major bleeding complications are independently associated with adverse mortality and major adverse cardiovascular event (MACE) outcomes, irrespective of the definition of major bleeding used, with the worst outcomes associate with non-access-site related bleeds. We consider the mechanisms through which bleeding complications may affect longer-term outcomes and discuss bleeding avoidance strategies, including access site choice, pharmacological considerations and formal bleeding risk assessment to minimise such bleeding events.
Eric W Holroyd - Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent
Ahmad HS Mustafa - Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester
Chee W Khoo - Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent
Rob Butler - Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent
Douglas G Fraser - Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester
Jim Nolan - Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent
Mamas A Mamas - Manchester Heart Centre, Manchester Royal Infirmary, CentralManchester University Hospitals NHS Trust, Manchester; The Farr Institute, University of Manchester, Manchester, UK
