Management of patients with HIT who require urgent CABG can be more difficult.534 9.7.2. Bleeding Complications Despite variable definitions for major and minor bleeding used in clinical trials, bleeding that complicates the course of an ACS, including STEMI, is independently associated with recurrent MI, stroke, death, longer hospital stay, and increased cost. The risk of death increases as a function of the severity of bleeding, independent of the success or failure of reperfusion therapy. In a pooled analysis from 4 ACS tri- als, the adjusted hazard ratio for death within 30 days ranged from 1.6 with mild bleeding to 10.6 with severe bleeding.535 Most bleeding is procedure related, although gastrointestinal and intracerebral bleeding may be more life threatening. Fac- tors likely to contribute to adverse outcomes with ACS-related These recommendations apply to patients who receive intracoronary stents during PCI for STEMI. Among individuals with STEMI who do not receive an intracoronary stent, the duration of DAPT beyond 14 days has not been studied adequately for patients who undergo balloon angioplasty alone, are treated with fibrinolysis alone, or do not receive reperfusion therapy. In this subset of patients with STEMI who do not receive an intracoronary stent, the threshold for initiation of oral anticoagulation for secondary prevention, either alone or in combination with aspirin, may be lower, especially if a shorter duration (ie, 14 days) of DAPT is planned.521 #CHADS2 (Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, previous Stroke/transient ischemic attack [doubled risk weight]) score. **Individual circumstances will vary and depend on the indications for triple therapy and the type of stent placed during PCI. After this initial treatment period, consider therapy with a vitamin K antagonist plus a single antiplatelet agent. 