Proton pump inhibitors are used in patients with a history of prior GI bleeding who require DAPT and are an option in patients at increased risk of GI bleeding.26,430 Evaluation of the risk of bleeding includes a focused his- tory of bleeding symptoms, identification of predisposing comorbidities, evaluation of laboratory data, and calculation of a bleeding risk score.688,716,725 Approximately 15% of all patients with NSTE-ACS and 3% to 12% of those not under- going CABG receive blood transfusion.702 Rates vary widely and are closer to the lower figure but increase in association with factors such as coronary intervention, anticoagulant/ antithrombotic therapy, older age, female sex, anemia, renal insufficiency, and frailty. Tissue oxygenation does not change or may actually decrease with transfusion.722 Blood transfu- sion in patients with ACS is associated with an increased risk of adverse outcome, including death.702 704 A restrictive trans- fusion strategy leads to an outcome that is at least as good, if not better, than a liberal transfusion strategy.699,700 An analysis of a large ACS registry found no benefit from blood transfu- sion in patients with a nadir hematocrit >24%.702 In a meta- analysis of 10 studies of patients with AMI, transfusion versus no transfusion was associated with an increase in all-cause A restric- tive approach to transfusion generally consists of no routine transfusion for a hemoglobin level >7 g/dL to 8 g/dL.699,700,727 A restrictive approach to blood transfusion is advocated by the American Association of Blood Banks700 and the European Society of Cardiology.727 On the basis of data available at the time of publication, a strategy of routine liberal blood transfu- sion in hemodynamically stable patients with NSTE-ACS and mild to moderate anemia is not recommended. See Online Data Supplement 31 for more information on anemia, bleeding, and transfusion. 