Bleeding is one of the most common complications among patients presenting with acute coronary syndrome (ACS) and is often precipitated by therapeutic intervention with potent antithrombotic medications and invasive procedures to restore perfusion to ischemic myocardium. Major bleeding is associated with short- and long-term morbidity and mortality, and percutaneous coronary intervention (PCI) related bleeding is now tracked as a hospital quality indicator in the United States. As antithrombotic therapy has become more potent, there may be concern that with contemporary ACS management, the risk of bleeding is even higher now that it has been in the past.