Patient selection: ACS managed invasively with angiography and/or percutaneous coronary intervention
Criteria for major bleed not associated with a CABG procedure:
(1) intracranial hemorrhage
(2) intraocular bleed
(3) bleeding at an access site requiring an intervention
(4) hematoma >= 5 cm in diameter
(5) drop in hemoglobin >= 3 g/dL with known source
(6) drop in hemoglobin >= 4 g/dL with an occult source
(7) reoperation for bleeding
(8) need for blood product transfusion
Risk factors for a major bleed:
(1) age >= 75 years
(2) female gender
(3) diabetes mellitus
(4) hypertension
(5) renal insufficiency (creatinine clearance < 60 mL/min by the Cockcroft-Gault equation)
(6) anemia (baseline hemoglobin < 12 g/dL in a woman and < 13 g/dL in a man)
(7) no previous history of a percutaneous coronary intervention
(8) elevation of cardiac biomarkers
(9) ST segment deviation >= 1 mm
(10) therapy with heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) (versus monotherapy with bivalrudin)
where:
• The odd ratios for the risk factors range from 1.2 to 1.95.
• The risk factors with odd ratios > 1.6: age, gender, anemia, anticoagulant
