The aim of this study was to determine the prevalence and significance predictors of major bleeding and the impact of major bleeding on outcomes, including mortality, in acute coronary syndromes (ACS). Hemorrhagic complications have been strongly linked with subsequent mortality in patients with ACS. Our study included ( 200) with ACS, factors associated with major bleeding were identified using logistic regression analysis. The incidence of major bleeding was 2.5% in patients with ACS. Advanced age ,interventional coronary angiography, low BMI, Clopidogrel loading > 300mg and renal insufficiency were independently associated with a higher risk of bleeding .The association remained after adjustment for hospital therapies and performance of invasive procedures.