Bleeding and Acute Coronary Syndromes: Defining, Predicting, and Managing Risk and Outcomes

Sharif      A. Halim; Sunil      V. Rao

Abstract

Acute coronary syndromes (ACS) continue to have a large impact on morbidity and mortality in the United States. Over the last two decades, there have been several advancements in the care of patients with ACS. The use of combined antiplatelet and anticoagulants and early invasive risk stratification in high risk patients has improved the rates of major adverse cardiovascular events. However, this treatment strategy increases the risk for bleeding. Studies have found an association between bleeding and subsequent mortality and morbidity in ACS patients; therefore, minimizing bleeding risk has become a priority. This review describes the prevalence of bleeding during ACS management, risk for bleeding, and strategies to reduce bleeding risk.

Keywords: Bleeding, acute coronary syndrome, mortality, antithrombotic and antiplatelet therapy, bleeding risk, CRUSADE, hemorrhagic complication, aspirin, anticoaguant