Evaluating hemorrhagic risk of antithrombotic therapy in patients with acute coronary syndrome

Due to prevention and minimization of ischemic complications, antithrombotic therapy with acute coronary syndrome is efficient and justified. However, bleeding as possible adverse effect leaves an open question: where is the boundary between it's benefit and safety. The bleeding is associated with up to seven times higher mortality during the first month from initiation of the antithrombotic therapy. The level of hemorrhagic risk depends on numerous factors: sex, age, comorbidities, clinical manifestations of acute coronary syndrome, clearance of creatinine, as well as on the therapeutic approach and location of bleeding. The aim of this paper was to point out the significance of evaluation of hemorrhagic risk when initiating and dosing the antithrombotic medication, in order to establish balance between effectiveness and safety and improve prognosis of the disease. Up to now, several scoring systems have been developed to evaluate the risk of bleeding, and their application is recommended on daily basis.