Major bleeding in acute coronary syndrome (ACS)

Major bleeding in acute coronary syndrome (ACS)

Most of the bleeds occur within 30 days of onset of acute coronary syndrome, but the risk continues. Major bleeding has been defined as one requiring two or more units of blood transfusion, 10% or more fall in hematocrit or resulting in death. Major bleed increases the risk of in hospital mortality by about 3-5 fold and the risk of re-infarction by about 2-3 fold.
Females have a higher chance of bleeding than males. Bleeding could be directly causal of mortality due to hypovolemia or shock. More important cause of mortality with bleeding in the setting of ACS is the withdrawal of antithrombotic drugs, rebound thrombosis and the effect of transfusions. Transfusions, especially, whole blood, is proinflammatory.