Optimal Upstream Management Bleeding Risk Assessment Basis for Assessment: Basis for Assessment: l Female > male l Old > young l CKD > normal renal function l Anemic > normal H/H l Diabetic > nondiabetic Options: Options: l Bivalirudin and fondaparinux associated with less bleeding than UFH and enoxaparin l Clopidogrel not reversible l GPIs increase bleeding risk but with renal-adjusted doses seem to have reasonable safety margin Basis for Assessment: Basis for Assessment: l Female > male l Old > young l CKD > normal renal function l Anemic > normal H/H l Diabetic > nondiabetic Options: Options: l Bivalirudin and fondaparinux associated with less bleeding than UFH and enoxaparin l Clopidogrel not reversible l GPIs increase bleeding risk but with renal-adjusted doses seem to have reasonable safety margin