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Bleeding is a frequently observed complication in patients suffering from acute coronary syndromes (ACS), as well as in patients submitted to percutaneous coronary interventions (PCI) or coronary artery bypass graft surgery (CABG). The rate of bleeding events varies greatly between reports, and depends mainly on the clinical setting, the baseline characteristics of the patients, the pharmacological environment, and the choice of vascular access in the case of invasive strategy. The rate of bleeding can also vary considerably depending on the scale used to measure haemorrhagic events. Among the many predictors of bleeding, the most powerful are age, sex, renal failure, use of glycoprotein (GP) IIb/IIIa inhibitors, vascular access, previous history of bleeding, and inappropriate dosage of antithrombotic therapies, particularly anticoagulants and GP IIb/IIIa inhibitors. Until recently, bleeding was considered to be inherent to the modern management of ACS, and was thought to be the price to pay to achieve an improvement in outcome. Basically, bleeding was a non-event. However, several reports have shown bleeding to be associated with a higher risk of death, myocardial infarction (MI), or stroke at 30 days and in the long term, irrespective of the clinical setting.1,2 In this context, a reduction in the rate of bleeding complications led to an improvement in outcome in at least two trials, and indeed even a reduction in death, MI, and stroke.3,4 The loop is therefore closed—more bleeding leads to an excess of death and ischaemic events, but less bleeding reduces the risk of death and ischaemic events.

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