# Bleeding Complications of Anticoagulation Therapy Used in the Treatment of Acute Coronary Syndromes—Review of the Literature

## TL;DR

This review discusses how balancing blood clot prevention and bleeding risks is crucial in treating heart attacks, highlighting new strategies to improve patient outcomes.

## Contribution

The paper emphasizes personalized antithrombotic regimens and emerging therapies to reduce bleeding risks in acute coronary syndrome treatment.

## Key findings

- Bleeding events significantly impact prognosis and mortality in acute coronary syndromes.
- Tailored dual antiplatelet therapy based on bleeding and thrombotic risks improves patient outcomes.
- Shortened DAPT protocols and P2Y12 inhibitor monotherapy show promise in minimizing bleeding risks.

## Abstract

Bleeding complications are a significant concern in the management of acute coronary syndromes (ACS). The evidence from clinical trials demonstrates the need for balancing efficacy in reducing ischemic events with safety concerns, as bleeding events adversely affect prognosis and mortality. Pharmacological agents like aspirin, P2Y12 inhibitors (e.g., prasugrel, ticagrelor), glycoprotein IIb/IIIa inhibitors, and heparins are fundamental to ACS treatment but carry varying bleeding risks depending on individual patient profile. Recent advancements in risk stratification tools have enabled tailored approaches to dual antiplatelet therapy (DAPT), optimizing its duration based on bleeding and thrombotic risks. Further Emerging therapies, including shortened DAPT protocols and P2Y12 inhibitor monotherapy, have shown promise in minimizing bleeding while maintaining clinical efficacy. The findings underscore the importance of personalized antithrombotic regimens in ACS management, emphasizing precise risk assessment to enhance outcomes and mitigate adverse events. This review examines the mechanisms, risk factors, and strategies to mitigate bleeding associated with anticoagulant and antiplatelet therapies in ACS.