Anticoagulant and antiplatelet therapy should be weight-based where appropriate and should be ad- justed when necessary for CKD to decrease the risk of bleeding in patients with NSTE-ACS.522,697,698 (Level of Evidence: B) Class III: No Benefit 1. A strategy of routine blood transfusion in hemody- namically stable patients with NSTE-ACS and hemo- globin levels greater than 8 g/dL is not recommend- (Level of Evidence: B) Anemia in patients with ACS is associated with an increased risk for Holter monitor detected recurrent ischemia and for MACE, with greater anemia correlating with greater risk.704 708 In 1 large analysisofmultiplestudies,theriskofadverseoutcomewashigher in patients with NSTE-ACS with hemoglobin levels <11 g/dL.704 The potentially detrimental effects of severe anemia include decreased myocardial oxygen delivery and increased MVO2 related to maintenance of a higher cardiac output.704,709,710 Patients with anemia are less likely to be treated with aspirin, and patients with ACS and anemia are likely to have more bleeding complica- tions with PCI.711 This has been correlated with increased short- term risk of MACE outcomes, including mortality; long-term risk The ACUITY study suggests that the risk of mortality associated with bleeding is at least as great as that associated with procedure-related or spontaneous MI.718 Major bleeding is a coprimary endpoint in many trials and is a consideration when assessing the net clinical ben- efit of a new drug. A universal definition of bleeding has been proposed to assist clinicians.547,719 721 The incidence of major bleeding in patients with ACS varies widely (0.4% to owing to differing definitions of major bleeding, patient populations, anticoagulation regimens, and PCI or CABG. 