Endoscopy 2025; 57(S 02): S525
DOI: 10.1055/s-0045-1806362
Abstracts | ESGE Days 2025
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Anticoagulation management after gastrointestinal bleeding: a cohort study of 236 patients

P Dániel
1   Department of Gastroenterology, Central Hospital of Nothern Pest – Military Hospital, Budapest, Hungary
2   Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
,
B Teutsch
3   Semmelweis University, Budapest, Hungary
,
N Vörhendi
4   Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
,
A O Simon
4   Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
,
E Boros
4   Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
,
L Frim
5   Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary
,
P Hegyi
2   Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
6   Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
,
T Gyökeres
7   Central Hospital of Northern Pest – Military Hospital, Budapest, Hungary
,
B Erőss
6   Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
8   Semmelweis University, Centre for Translational Medicine, Budapest, Hungary
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Aims Restarting anticoagulation (AC) therapy following acute gastrointestinal bleeding (GIB) is a multidisciplinary, personalized decision. Current guidelines recommend resuming AC, though data on the optimal timing is limited. We aim to assess the short-term effect of AC therapy resumption after acute GIB and their relationship with the timing of AC restart.

Methods Participants enrolled in the Hungarian GIB Registry between 2019 and 2022 were analyzed. Patients were included after successful management of AC-related GIB. Detailed demographic and anamnestic parameters, index bleeding characteristics, and management data were collected. We formed multiple groups based on the resumption date of AC therapy (restarted within 7 days /Group 7/, 5 days /Group 5/ or 3 days /Group 3/). To adjust for confounders, we performed subclassification propensity score matching for each group (included factors: age, sex, Charlson Comorbidity Index, chronic kidney disease, active cancer, HAS-BLED score, major index bleeding, endoscopic intervention, and comedications). We assessed 30 and 90-day rebleeding, thromboembolic (TE) complications, recurrent GIB or TE-related mortality during the 90-day follow-up period. We performed a survival analysis. Cox regression model assessed the outcomes' Hazard Ratio (HR) with 95% confidence intervals (CI).

Results 236 cases were enrolled. In 218 cases, AC therapy was resumed during the follow-up period (92,37%). Rebleeding occurred in 16 cases (6,78%) in the first 30 days and 18 cases (7,62%) in 90 days. Two (0,84%) thromboembolism appeared in 30 days and 6 (2,54%) in 90 days. Rebleeding-related mortality was observed in one case (0,42%) during the first 30 days, while TE-related mortality did not occur. HR(95% CI) of 30 days rebleeding in groups 7, 5 and 3 were 0.61 (0.14-2.54); 1.21 (0.39-3.71) and 0.81 (0.24-2.76), respectively, while HR(95% CI) of 30 days TE event were 0.39 (0.06-2.38), 0.93 (0.15-5.72) and 0.95 (0.16-5.39) respectively.

Conclusions Rebleeding is a relevant complication of AC therapy resumption after GI bleeding. In our results, an earlier medication restart was not associated with elevated rebleeding risk. Due to the low sample size and short follow-up, we can not prove AC therapy's beneficial effect on thromboembolic prevention.



Publication History

Article published online:
27 March 2025

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