Risk Stratification for Bleeding in the Elderly with Acute Coronary Syndrome: Not So Simple

Acute coronary syndromes (ACSs) are more prevalent in the elderly, who benefit from early invasive management and antithrombotic therapy similar to younger individuals but are also more prone to bleeding in the aftermath of percutaneous coronary intervention (PCI).[1] Indeed, the management of ACS has advanced greatly over the years,[2] but determining the risk of post-discharge bleeding in the elderly remains a primary clinical challenge, because bleeding impacts on mortality and increases with the intensity and duration of dual anti-platelet therapy.[3] This issue is even more complex in elderly patients who have co-existing reasons to assume oral anticoagulant medications (e.g. atrial fibrillation, venous thromboembolism).[4]