Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

Abstract

Major bleeding is currently one of the most common non-cardiac complications observed in the treatment of patients with acute coronary syndrome (ACS). Hemorrhagic complications occur with a frequency of 1% to 10% during treatment for ACS. In fact, bleeding events are the most common extrinsic complication associated with ACS therapy. The identification of clinical characteristics and particularities of the antithrombin therapy associated with an increased risk of hemorrhagic complications would make it possible to adopt prevention strategies, especially among those exposed to greater risk. The international societies of cardiology renewed emphasis on bleeding risk stratification in order to decide strategy and therapy for patients with ACS. With this review, we performed an update about the ACS bleeding risk scores most frequently used in daily clinical practice.

Keywords: Bleeding, Acute coronary syndrome, Risk scores, Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines, Acute Coronary Treatment and Intervention Outcomes Network

Core tip: Bleeding is the main non-thrombotic complication associated with acute coronary syndrome. Bleeding implies a worse prognosis due itself directly (fatal bleeding, for example, intracranial bleeding) and indirectly (discontinuation of antithrombotic therapy). For this it is important to do an adequate bleeding risk stratification in all patients with acute coronary syndrome. In this review we analyze the different risk factors for bleeding, along with the bleeding risk scores currently available.