In Hospital Assessment and Management of High Bleeding Risk in Patients with ST-Elevation Myocardial Infarction (STEMI)

Bleeding risk assessment is a critical component of the management of patients with ST-segment elevation myocardial infarction (STEMI), yet the optimal approach to risk stratification remains controversial. Although several bleeding risk scores have been developed, their predictive performance in STEMI populations is still evolving. Importantly, bleeding risk in STEMI is dynamic and influenced by clinical status, procedural factors, and antithrombotic strategies, underscoring the need for continuous reassessment throughout hospitalization. Bleeding avoidance measures—including radial access, judicious use of anticoagulation, and individualized antiplatelet therapy—play a pivotal role in reducing complications. Balancing ischemic and hemorrhagic risks is particularly challenging in patients with concomitantly high thrombotic and bleeding risks, requiring tailored management strategies. As bleeding remains a major determinant of prognosis, refining risk stratification tools and integrating evidence-based bleeding prevention strategies into clinical practice are essential. This narrative review summarizes the current evidence regarding the identification of high bleeding risk in hospitalized patients with STEMI and discusses its clinical implications. Also, this review proposes a dynamic, phase-specific framework for in-hospital bleeding risk assessment and management in patients with STEMI.