Benefits and risks with antiplatelet therapy: how great a problem is bleeding?

Significant advances in treatment strategies for patients with acute coronary syndromes (ACS) have been made over the past 10 years, including the introduction of new antiplatelet therapies. Additionally, modifications have been made in the dosing of these agents, the duration of treatment has been increased, and they are used in dual- and triple-therapeutic regimens. On the basis of a number of large-scale clinical trials, the current guidelines recommend the use of aspirin in combination with clopidogrel as a first-line therapy in patients with ACS. While data show significantly reduced ischaemic events with combination antithrombotic therapy, this is often associated with an increase in major bleeding episodes. Because of these risks, it is important that treatment with antithrombotics follow appropriate guidelines with a risk/benefit ratio calculated for each patient. Additionally, agents with the lowest bleeding risk should be used first. This article reviews the benefits and risks of antiplatelet therapy with emphasis on the potential for serious bleeding episodes.