STEMI-The importance of balance between antithrombotic treatment and bleeding risk

The incidence of ST elevation myocardial infarction (STEMI) is around 66 STEMI per 100 000 of population/year, with 6-12% hospital mortality in unselected patients [1]. Modern treatment strategies for STEMI are based on immediate antithrombotic treatment and primary percutaneous coronary intervention (PCI) with stent implantation. Therapy with a combination of two or even three more potent antiplatelet and anticoagulant agents reduces both short-term and long-term ischemic risk, morbidity and mortality; on the other hand it is associated with higher risks of bleeding. The first part of this review is focused on the pathogenesis of thrombi in STEMI patients and antithrombotic drugs currently used to treat STEMI patients. In the second part we discuss several factors that can affect bleeding risks including the choice of access site for coronary angiography, prevention and treatment of bleeding in STEMI patients. Finding a balance which minimizes both thrombotic and bleeding risk is crucial, although, it can be difficult and further randomized studies directed at finding this balance are needed.