Editorial: do we need another bleeding definition? What does the Bleeding Academic Research Consortium definition have to offer?

Purpose of review To define why a standardized bleeding definition is required and discuss the merits of the Bleeding Academic Research Consortium (BARC) definitions. Recent findings In acute coronary syndromes, bleeding is related to increased mortality, myocardial infarction, and stroke. As newer antiplatelet and antithrombotic agents are developed for the treatment of cardiovascular disease, bleeding rates will increase. Multiple bleeding definitions have been used in trials and registries. This makes comparisons across studies difficult. In order to standardize definitions, the Bleeding Academic Research Consortium (BARC) has developed a consensus classification for bleeding. Six types are hierarchically defined from type 0 in which there is no bleeding to type 5 with fatal bleeding. Type 1 is in which the patient does not seek treatment. Type 2 is in which intervention or admission to hospital occurs. Type 3a is overt bleeding plus hemoglobin drop of 3 to less than 5 g/dl or transfusion. Type 3b is overt bleeding plus hemoglobin drop of at least 5 g/dl, cardiac tamponade, bleeding requiring surgical intervention or intravenous vasoactive agents. Type 3c is intracranial hemorrhage or intraocular bleeding compromising vision. Type 4 is coronary artery bypass grafting-related bleeding and type 5 is fatal bleeding. Summary The BARC definition will have wide applicability in trials, registries, and clinical practice. Although prospective validation is required, the definition will allow uniform reporting and comparison across studies.