A significant proportion of patients undergoing percutaneous coronary intervention (PCI) is deemed at high bleeding risk. Definition and identification of high bleeding risk patients at the time of PCI is extremely important to inform decision-making regarding antithrombotic treatment selection and optimize the balance between ischemic and bleeding risk. The recent introduction of standardized definitions and tools to identify and treat patients at high bleeding risk is promising to improve evidence-based care in this subgroup of patients.