Coronary interventions in patients with bleeding and bleeding tendency

In general, percutaneous coronary intervention (PCI) is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system. The patients who currently bleed may not tolerate any short term anticoagulant effect. The patients who are easy to bleed may have annoying and prolonged bleeds especially at the surgical or vascular access site while on long term antiplatelet drugs such as clopidogrel or aspirin (ASA). These patients in critical situation such as acute myocardial infarction (AMI) or unstable angina may need to undergo PCI, in spite of the fact that the operators have difficulty in predicting the risk of or controlling further bleed-ing before or during PCI. Any patients whose bleeding cannot be controlled after PCI should not undergo PCI because they will succumb from hemorrhagic shock. These patients are listed in Table 1.