Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .
Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI 
OBJECTIVES This study sought to develop a risk score predictive of bleeding in patients undergoing percutaneous coronary intervention ( PCI )  and to investigate the impact of bleeding on subsequent mortality . BACKGROUND Bleeding complications after PCI have been independently associated with early and late mortality . METHODS This study represents a patient-level pooled analysis including 17,034 patients undergoing PCI from 3 large , r and omized trials of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors , including the REPLACE-2 ( R and omized Evaluation of PCI Linking Angiomax to Reduced Clinical Events ) , ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) , and HORIZONS-AMI ( Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infa rct ion ) trials . We developed a risk score to predict noncoronary artery bypass graft (CABG)-related TIMI ( Thrombolysis In Myocardial Infa rct ion ) major bleeding and evaluated the impact of various types of bleeding on 1-year mortality . RESULTS A non-CABG-related TIMI major bleed occurred within 30 days in 267 patients ( 1.6 % ) , and death occurred in 497 patients ( 2.9 % ) within 1 year . A risk score was developed to predict the bleeding risk of patients undergoing PCI  , consisting of 7 variables ( serum creatinine , age , sex , presentation , white blood cell count , cigarette smoking , and r and omized treatment ) . The TIMI major bleeding rates increased by bleeding risk score groups : from 0.4 % for those in the lowest to 5.8 % for those in the highest risk group . Non-CABG-related TIMI major bleeding and the occurrence of myocardial infa rct ion within 30 days were independent predictors of subsequent mortality , with respective hazard ratios of 4.2 and 2.9 , each p < 0.001 . Ranked in order of severity , TIMI major bleeding , blood transfusion without TIMI bleed , TIMI minor bleeding requiring blood transfusion , and TIMI minor bleeding not requiring blood transfusion were independent predictors of subsequent mortality with hazard ratios of 4.89 , 2.91 , 2.73 , and 1.66 , respectively . Isolated hematomas were not predictive of subsequent mortality . CONCLUSIONS Non-CABG-related bleeding within 30 days is strongly associated with an increased risk of subsequent mortality at 1 year in patients undergoing PCI  for all indications . A risk score was established to calculate the bleeding risk for patients undergoing PCI  , allowing therapeutic decision making to minimize the incidence of bleeding
Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .