ABSTRACT
The use of potent contemporary anti-thrombotic and anti-platelet agents in conjunction with an early invasive strategy has improved ischaemic outcomes in patients presenting with acute coronary syndromes. However, these have an inherent tendency to increase the risk of bleeding complications. Bleeding events and need for blood transfusion have a significant impact on early and long-term morbidity and mortality in ACS.
The risk factors identified which increase the haemorrhagic complications include advanced age, female sex, low body weight, obesity, hypertension, heart failure or shock, diabetes mellitus, chronic kidney disease, anaemia, sepsis, prior history of GI bleeding or stroke, NSTEMI (vs. unstable angina), use of invasive procedures and use of anti-platelet and/or anti-thrombotic drugs. Adding a proton-pump inhibitor, reduced arterial sheath size, timely sheath removal, and the use of radial instead of femoral artery access for PCI are associated with a significant decrease in peri-procedural bleeding rates.
Hence, each patient should undergo a detailed assessment of the baseline haemorrhagic risk as well as the ischaemic risk and should accordingly receive individualised treatment. Minimisation of bleeding events while maintaining anti-ischaemic effectiveness should be the therapeutic target in the management of ACS in order to reduce morbidity, mortality and healthcare costs.
