Bleeding management and pharmacological strategy in primary percutaneous coronary intervention

Until recently, achievements in the treatment of acute coronary syndromes (ACS) could only be obtained with an increased risk of bleeding. Though long considered an unavoidable consequence of the treatment of ACS, recent data demonstrate that major bleeding has a serious impact on subsequent outcomes. These findings have brought a paradigm change to risk stratification that takes into account not only ischaemic risk, but also bleeding risk in the selection of an optimal management strategy. Strategies to reduce bleeding include assessment of the bleeding risk in each individual patient, appropriate dosing of antithrombotic drugs, and the use of drugs with proven reduced risk of bleeding in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.