Abstract
Dual antiplatelet therapy with 75-100 mg Acetyl Salicylic Acid (ASA) and a novel antiplatelet (Adenosine Diphosphate Receptor inhibitor or P2Y12 inhibitor) is the current standard of care following Acute Coronary Syndromes i.e. ST Elevation Acute Coronary Syndrome (STEACS), Non-ST Elevation Acute Coronary Syndrome (NSTEACS) and unstable angina [1]. The Platelet Inhibition and Patient Outcomes (PLATO) trial showed that the oral P2Y12 inhibitor Ticagrelor has significant clinical superiority compared with clopidogrel in the reduction of mortality, recurrent myocardial infarction, instent restenosis and stroke at one year [2]. Despite improved efficacy, Ticagrelor prescription increased peri-procedural and spontaneous bleeding ranging from minor to fatal events [3]. Reduction of blood volume and anaemia can lead to complications such as hypovolaemic shock and myocardial ischaemia due to supply and demand imbalance (type 2 myocardial ischaemia). Bleeding within 30 days post event is shown to impact long-term prognosis adversely. Furthermore, non-access site bleeding increases one year mortality rate to two-fold [4]. Multiple studies with various baseline demographics using various bleeding definitions including Thrombolysis In Myocardial Infarction (TIMI), Bleeding Academic Research Consortium (BARC) and Platelet Inhibition and Patient Trial (PLATO) show different predisposing factors
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