It is hoped that this simple scoring system for identifying patients at increased risk of bleeding can be used as a tool for individualization of the treatment strategy for each patient, similar to an easily applied scale for predicting the risk of bleeding versus thrombotic events which has begun to be used in general practice in patients with atrial fibrillation, leading to a recommendation of optimal therapy: HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile International Normalized Ratio, Elderly, Drugs/alcohol concomitantly) score and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age of at least 75 years, Diabetes mellitus, Stroke, Vascular disease, Age of 65 to 74 years, Sex category) score. Four categories of bleeding are then defined according to the total integer score: low (20). This simple integer-based scoring system calculates individual risk scores by using six independent measurements of factors that have been identified to be associated with an increased risk of bleeding complications (gender, age, serum creatinine, white blood cell count, anemia, and presentation), combined with the type of anticoagulation therapy applied (heparin + inhibitors of GP IIb/IIIa versus bivalirudin monotherapy). Because these risk factors have been identified, the scale for predicting the risk for the development of major bleeding complications in patients with ACS has been evaluated on the basis of results from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) and the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trials. Additionally, women and patients with renal insufficiency were found to exhibit a higher risk of hemorrhage and the risk rate is also associated with the use of invasive techniques and the sheath size. Older age is a strong independent risk factor for major bleeding during hospitalization, and this risk factor increases by approximately 30% per decade of age. These factors are age, gender, body weight, renal insufficiency, and the techniques used in invasive procedures. Several factors associated with an increased risk of periprocedural bleeding have been identified. These varying results come from trials examining different demographic data, access sites, cardiac catheterization techniques, and pharmacotherapy regimes and from randomized studies in which specific defined groups of patients are included and which do not reflect the real-world clinical experience. The incidence of bleeding complications in trials with patients with ACS varies, ranging from 2.0% to 17.6%. If it is expected that more attention will be focused on this issue in the future, this attention should concurrently lead to a special effort of creating one standard bleeding complication classification which is necessary for unambiguous comparison of outcomes from clinical trials evaluating treatment strategies in ACS. As a result of these findings, bleeding complications, which have been disregarded for quite some time, have become a highly significant medical and economic problem. All of these actions lead to an increased risk of bleeding complications in these patients which is significantly associated with worse short-term and long-term prognoses. Owing to the development of new techniques for cardiac catheterization and the continual production of new generations of highly effective antiplatelet drugs, the care of patients with ACS has improved, resulting in reductions in rates of death due to ischemic events as well as periprocedural ischemic complications, ischemic stroke, and heart failure. As a result of the more widespread application of selective coronary angiography and PCI in general practice, a greater number of older people and patients with serious comorbidities are receiving this procedure. Selective coronary angiography as a diagnostic method followed by percutaneous coronary intervention (PCI) as a therapeutic method has become routine practice for patients with acute coronary syndrome (ACS) as well as for patients with stable forms of ischemic heart disease.

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