Bleeding and transfusion in the setting of ACS

Anticoagulant and antiplatelet therapies are cornerstones in the management of ACS, yet each of these therapies is associated with an increased risk of bleeding. A number of analyses suggest that both bleeding events in the setting of ACS and the transfusions they provoke are associated with an increased risk of adverse outcomes. To add complexity to the situation, many definitions of bleeding exist and make comparisons of different agents difficult. Multiple approaches can decrease bleeding risk, including careful dosing of anticoagulant and antiplatelet therapies, use of newer antithrombin agents, and careful vascular access or alternative vascular access during cardiac catheterization and percutaneous coronary intervention. Additionally, treatment paradigms for anemia and blood transfusion thresholds in ACS patients should be further explored in order to limit the number of transfusions performed.