5,13 Clinical risk factors for in-hospital bleeding have been identified in analyses of several contemporary ACS trials and registry databases. Rates of major bleeding in clinical studies of ACS have ranged from 0.8% to 11.5% 5,6,13,14 and, according to some registries, it is the most common non-cardiac complication of therapy in this patient population. Aetiology and Risk Factors for Bleeding in ACS 5-9 Furthermore, the safety of blood transfusion in this population has also been called into question, 10-12 suggesting that management strategies that maintain an adequate anticoagulant effect to reduce ischaemia, while at the same time minimising the risk of bleeding, may further improve ACS outcomes. Recent studies suggest that bleeding is independently associated with an increased risk of both short- and longer-term adverse events (including MI, stroke and death) among patients with ACS. 3,4 Despite improvements in endpoints such as death, myocardial infarction (MI) and recurrent ischaemia, these therapies are not without their risks, namely bleeding and blood transfusion. 1,2 Additionally, management algorithms favouring early invasive intervention in high-risk patients are gaining support. Increased implementation of evidence-based antithrombotics and antiplatelet agents has led to improved patient outcomes. There has been a significant evolution in the management of patients with acute coronary syndromes (ACS), largely driven by advances in pharmacological therapy.
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