title: Major bleeding: management and risk reduction in acute coronary syndromes.
abstract: BACKGROUND
  Guidelines for the management of high-risk non ST-segment elevation acute coronary syndrome (NSTE ACS) recommend antithrombotic and antiplatelet therapy combined with an early invasive strategy. While this strategy reduces ischemic complications, it places patients at risk for bleeding complications.
  
  
  OBJECTIVE
  We sought to provide a narrative review of the risk factors for bleeding, risks associated with bleeding and strategies to prevent bleeding complications.
  
  
  METHODS
  A comprehensive literature review was performed to identify relevant evidence.
  
  
  CONCLUSIONS
  Bleeding complications in NSTE ACS are associated with adverse events and higher mortality. Prevention of bleeding complications can be achieved through judicious dosing of medications, the use of antithrombotic agents associated with a lower bleeding risk and use of the radial artery approach in patients requiring coronary intervention. Future work should focus on delineating the mechanisms underlying the bleeding-mortality relationship and developing a better understanding of the tradeoff between efficacy and safety.
authors.affiliation: Duke University Medical Center, Department of Medicine, Box 31110 Durham, NC 27710, USA. matt.cavender@duke.edu
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D017534:Radial Artery / Q000378:metabolism; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors