Upper gastro intestinal bleeding in patients on antithrombotic drugs: do we need to worry?

Aims This study aims to evaluate the effect of antithrombotic (AT) therapy on endoscopic outcomes in patients admitted with upper gastrointestinal bleeding (UGIB)

Methods We conducted a prospective, single-center cross-sectional study involving 332 patients between June 2020 and August 2024. Patients were categorized as AT users if they were taking antiplatelet agents (low-dose aspirin, thienopyridines) and/or anticoagulants (vitamin K antagonists, direct oral anticoagulants, or heparin).

Results The mean age was 59±16.7 years, with a strong male predominance (77.1%). A total of 63 patients (19%) were on AT therapy (41 on antiplatelets and 39 on anticoagulants). The AT group was older (68 vs. 57 years; p<0.001) and had a higher prevalence of comorbidities (75.8% vs. 16.7%; p<0.001). However, no statistically significant differences were found between the groups in terms of active bleeding during endoscopy (12.7% vs. 16.8%; p=0.425) or the need for endoscopic hemostasis (7.9% vs. 16%; p=0.1). In multivariate analysis, after adjusting for age, sex, comorbidities, presence of active bleeding, and AT use, only active bleeding significantly predicted the need for endoscopic hemostasis. Specifically, active bleeding at endoscopy increased the likelihood of requiring hemostasis by 26 times (OR: 26, CI: 12.9–62.15, p<0.001), while AT use did not independently affect the need for hemostasis (OR: 0.386, CI: 0.105–1.42, p=0.154).

Conclusions Older patients on AT therapy admitted with UGIB do not appear to have an elevated risk of active bleeding during endoscopy or a higher likelihood of requiring endoscopic hemostasis.

Publication History

Article published online:
27 March 2025