In dubious battle: bleeding versus ischemic events

Excerpt

Bleedings have become a major clinical issue since the work by Kinnaird et al. suggesting that they were associated with short and long-term mortality [1]. Before these findings, the main goal of the therapy was to reduce ischemic events through the development of more potent antithrombotic agents. Since the demonstration of the high clinical cost of bleedings in acute coronary syndrome patients, focus has shifted to promoting an optimal but not excessive antithrombotic therapy to prevent ischemic events without increasing bleedings. Accordingly, recent trials of antithrombotic agents in ACS have used ischemic events as primary endpoint and bleedings as secondary in order to enable evaluation of the net clinical benefit [2, 3]. A major advance in the field was the publication of a new classification of bleedings to further promote unskewed comparisons between trials. The Bleeding Academic Research Classification (BARC) was published in 2012 and correlates with the clinical outcome [4, 5]. …