In patients with an MMRS < 10 , TRA was used in 71,771 ( 43.2 % ) of 166,083 PCI procedures ; TRA was used in 8,655 ( 40.1 % ) of 21,559 PCI procedures in patients with an MMRS 20 , illustrating that TRA was used less in those at highest risk from bleeding complications ( p < 0.0001 ) .