In recent years, there has been a significant focus on finding the optimal medical treatments and their durations, particularly patients undergoing percutaneous coronary intervention (PCI), who present with concurrent high bleeding risk (HBR) and high thrombotic risk (HTR). As such there’s, been an evolution of risk assessment frameworks, such as the Academic Research Consortium for High Bleeding Risk (ARC-HBR), which discusses the nuanced approaches required to balance the prevention of thrombotic events against minimizing bleeding risks. Through the lens of the ARC-HBR trade-off model and the role of dual antiplatelet therapy (DAPT), the chapter emphasizes the importance of a personalized, evidence-based approach. It advocates for integrated decision-making and patient-centered care to navigate the complexities of managing HBR and HTR, ultimately aiming to optimize patient outcomes in coronary interventions.