After this initial treatment period, consider therapy with a vitamin K antagonist plus a single antiplatelet agent. For patients treated with fibrinolysis, consider triple therapy for 14 days, followed by a vitamin K antagonist plus a single antiplatelet agent.522 525 bleeding include patient comorbidities,536,537 discontinuation of antiplatelet or anticoagulant therapy in response to bleeding,536,538 and blood transfusion.539,540 Additional considerations include types of antiplatelet or anticoagulant agent at time of PCI,248,541,542 number of antithrombotic agents used,533 duration of therapy, crossover from low-molecular-weight heparin to UFH, HF or shock, diabetes mellitus, peripheral artery disease, and prior warfarin use. If triple antithrombotic therapy is required after discharge, the risk of bleeding increases (Figure 4).533 Risk factors for bleeding in patients with ACS have been identified from several clinical trials535,544 546 (Table 13). Predictive models for major bleeding in patients with ACS and in patients undergoing PCI have been reported from the NCDR ACTION Registry GWTG.547,548 An analy- sis from the ACTION Registry GWTG suggests that the CRUSADE bleeding risk score, developed in patients with non ST-elevation MI, may be extended to the STEMI popula- Major bleeding occurred in 2.8% of >40000 patients with acute MI in the GRACE Registry.536 Patients who expe- rienced a major bleeding episode were more likely to die in hospital than were those who did not bleed (20.9% versus 5.6%; P<0.001), even after adjustment for several relevant demographic and clinical variables. One in 5 patients with a major bleed did not survive to hospital discharge; these patients accounted for 10% of all hospital deaths and were older, more severely ill, and more likely to undergo invasive proce- dures. 