Resuming Anticoagulants and/or Antiplatelets after Gastrointestinal Bleeding: does time Really Matter?

Aims Anticoagulants (AC) and antiplatelets (AP) have a pivotal role in the prevention and treatment of cardiovascular (CV) diseases, but managing major gastrointestinal bleeding (GIB) in these patients represents a challenge. The dilemma is whether, when, and how to restart AC/AP after GIB.

Aims To determine if the length of AC/AP interruption (≤7 vs. >7 days after haemostasis achievement) affects the rate of recurrent GIB, vascular events and all-cause mortality.

Methods Retrospective review of GIB (upper, lower, or middle) admissions of AC/AP users, from January 2016 to December 2019. Patients with variceal or tumoral bleeding were excluded. We assessed post-discharge readmissions due to vascular events (myocardial infarction, stroke, or thromboembolism) within 1 year and due to GIB within 90 days. Timing and cause of death during follow-up were recorded.

Results Included 213 patients (average age 78.1±9.4 years; 61.5 % male). 51 were treated with warfarin, 49 with direct oral AC and 113 with AP. The main indications for AC/AP therapy were atrial fibrillation (39 %), cerebrovascular disease (24.4 %) and ischemic heart disease (18.8 %). 95.3 % discontinued AC/AP after major GIB and 81.2 % resumed AC/AP during follow-up (median 5.0 days; interquartile range 1-9 days). 64.8 % resumed therapy within 7 days. We found a 1-month mortality rate of 8.5 %. Restarting AC/AP≤7 days was not associated with all-cause mortality at 1 month (Odds Ratio (OR) 1.47; 95 % CI 0.97–2.50) and recurrent GIB at 90 days (OR:1.07; 95 % CI 0.74–1.56). Resuming treatment ≤7 days was associated with a significantly lower proportion of vascular events within 1 year (OR: 2.24 95 % CI 1.28–3.86; p=0.001).

Conclusions Our results highlight that early resuming AP/AC therapy was not associated with higher risk of short term-mortality and rebleeding, instead delaying AP/AC therapy may increase the risk of CV and thromboembolic events.

Citation: Sequeira C, Costa Santos I, Coelho M et al. OP148 RESUMING ANTICOAGULANTS AND/OR ANTIPLATELETS AFTER GASTROINTESTINAL BLEEDING: DOES TIME REALLY MATTER?. Endoscopy 2021; 53: S61.

Publication History

Article published online:
19 March 2021