Purpose of Review <p>Historically, clinical trials evaluating percutaneous coronary intervention (PCI) excluded patients at increased risk for bleeding. The goal of this review is to define the high bleeding risk (HBR) phenotype, the prevalence and outcomes of this patient population, and evaluate recent evidence for bleeding risk reduction strategies.</p> Recent Findings <p>The prevalence of patients at HBR undergoing PCI in usual care clinical registries varies between 34 and 44% with one-year rates of major bleeding exceeding 7%. Rates of ischemic events are also higher among those with versus without HBR, thus complicating decision-making with respect to provision antiplatelet therapy.</p> Summary <p>The safety and efficacy of various dual antiplatelet (DAPT) de-escalation strategies have been examined in several clinical trials. Compared with conventional DAPT, early discontinuation of DAPT followed by single antiplatelet therapy (SAPT), switching from a potent P2Y₁₂ inhibitor to a less potent agent or reducing the dose of P2Y₁₂ inhibitor reduce bleeding risk while maintaining ischemic efficacy.</p>