Background

Bleeding is one of the most important complications of interventional cardiology procedures, particularly percutaneous coronary intervention (PCI), structural heart intervention, and complex coronary revascularization. Bleeding events are associated with prolonged hospitalization, transfusion, interruption of antithrombotic therapy, recurrent ischemic events, and increased mortality.

Objective

To evaluate contemporary bleeding risk assessment in interventional cardiology, including patient-related predictors, procedural contributors, validated risk scores, and practical prevention strategies.

Methods

A multicenter observational study was designed involving 850 patients undergoing interventional cardiology procedures. Baseline clinical variables, laboratory parameters, antithrombotic regimens, access-site characteristics, and procedural complexity were analyzed. Bleeding was classified using BARC criteria. Predictive performance of ARC-HBR, PRECISE-DAPT, HAS-BLED, and institutional procedural risk models was compared.

Results

Overall clinically relevant bleeding occurred in 8.9% of patients. Major bleeding was observed in 3.4%. Independent predictors included advanced age, chronic kidney disease, anemia, oral anticoagulant use, femoral access, complex PCI, and prolonged procedural duration. Radial access significantly reduced access-site bleeding. ARC-HBR showed strong clinical utility for identifying high-risk patients, while PRECISE-DAPT was particularly useful for guiding antiplatelet duration.

Conclusion

Bleeding risk assessment is essential in contemporary interventional cardiology. A combined approach using validated risk scores, clinical judgment, procedural planning, and individualized antithrombotic therapy can reduce bleeding complications while maintaining ischemic protection.