Balancing myocardial ischemic and bleeding risks in patients with non-ST-segment elevation myocardial infarction

Achieving an appropriate balance of anti-ischemic efficacy versus bleeding risk with antiplatelet and anticoagulant agents demands an accurate estimation of risks. Although traditional risk stratification is available to decrease complications, and various methods of stratifying these risks have been proposed and validated, the stratification of bleeding risk is in its infancy. However, no model currently available permits the simultaneous estimation of these risks. Ischemic risk may be determined using 1 of several validated models, followed by the estimation of bleeding risk according to known risk factors. After selecting appropriate pharmacotherapy on the basis of the stratification of these risks, attention must be paid to proper dosing according to individual risk factors and patient, clinical, and technical variables. The aim of this study was to examine risk stratification models for these parameters to determine clinical characteristics common to ischemia and bleeding that can be used to minimize risks. A "bleeding risk subscale" is proposed, with factors extrapolated from current ischemic risk models, to integrate ischemic mortality and bleeding risk in patients with non-ST-segment elevation acute coronary syndromes. In conclusion, a validated tool to simultaneously evaluate ischemic and bleeding risk will help determine the most well-balanced pharmacotherapy for patients with non-ST-segment elevation acute coronary syndromes.