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Bleeding has recently been identified as a major adverse outcome in patients with acute coronary syndromes. In this review, the importance of the association of bleeding with mortality and strategies to reduce bleeding with percutaneous coronary intervention are discussed.Nine trials have shown an association of bleeding with mortality. The influence of major bleeding is at least equivalent to the effect of a myocardial infarction. In order to reduce bleeding, individualized risk assessment should be performed and attention paid to choice of access, antithrombotic, dose of antithrombotic, avoidance of crossing over from one antithrombotic to another, smaller sheaths and early removal as well as choice of P2Y12 inhibitor.Individualizing treatment and strategies to reduce both ischemic events and bleeding will improve patient outcomes.