title: Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention.
abstract: The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%-10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%-14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, VA Medical Center and University of Tennessee Health Science Center, Memphis, TN, USA. ppham@mednet.ucla.edu
authors.forename: Phuong-Anh
authors.initials: PA
authors.lastname: Pham
authors.forename: Phuong-Thu
authors.initials: PT
authors.lastname: Pham
authors.forename: Phuong-Chi
authors.initials: PC
authors.lastname: Pham
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Miller
authors.forename: Phuong-Mai
authors.initials: PM
authors.lastname: Pham
authors.forename: Son V
authors.initials: SV
authors.lastname: Pham
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors