Key result
Resuming antiplatelets >7 days after post-PCI GIB is linked to ~34% less rebleeding but more vascular events.
Why the study?
Antiplatelet management in patients hospitalised for gastrointestinal bleeding after PCI requires balancing risks of rebleeding and clinical vascular events.
Does delaying antiplatelet resumption > 7 days post-endoscopy reduce rebleeding or increase clinical vascular events in patients hospitalized with post-PCI gastrointestinal bleeding?
Cohort (n=3,848)
Yes
Does delaying antiplatelet resumption > 7 days post-endoscopy reduce rebleeding or increase clinical vascular events in patients hospitalized with post-PCI gastrointestinal bleeding?
Delaying antiplatelet resumption beyond 7 days after endoscopy for post-PCI gastrointestinal bleeding reduces 30-day rebleeding but increases 90-day clinical vascular events, suggesting an optimal resumption window of 3-4 days.
Suggests optimal antiplatelet resumption at 3-4 days post-endoscopy in post-PCI GI bleeding; hypothesis-generating cohort study leaves optimal timing open pending RCTs.
Background Antiplatelet management in patients hospitalised for gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) requires balancing risks of rebleeding and clinical vascular events. Aims Evaluate the impact of antiplatelet resumption timing post‐endoscopy on rebleeding and clinical vascular events. Methods We performed a retrospective nationwide cohort study of patients hospitalised with post‐PCI GIB on dual antiplatelet therapy (DAPT) using the Vizient Clinical Database. Co‐primary outcomes were 30‐day rebleeding and 90‐day clinical vascular events after endoscopy. Multivariable Cox proportional hazards regression analysis was performed. Results Among 2979 patients with both antiplatelet agents held before endoscopy for GIB (46.0% upper; 34.8% lower), antiplatelet resumption > 7 days post‐endoscopy was associated with decreased 30‐day rebleeding (hazard ratio [HR] 0.66; 95% confidence interval [CI] [0.49–0.87]) and increased 90‐day clinical vascular events (HR 1.18 [1.02–1.36]) compared to restarting ≤ 1 day post‐endoscopy. Among 869 patients with one antiplatelet agent held before endoscopy for GIB (47.3% upper; 36.3% lower), resumption at > 7 days vs. ≤ 1 day had HR 0.69 (0.41–1.14) for rebleeding and HR 1.41 (0.97–2.04) for clinical vascular events. HRs for antiplatelet resumption > 3 days vs. ≤ 1 day post‐endoscopy were similar. Conclusions Antiplatelet resumption > 7 days after endoscopy in patients hospitalised with post‐PCI GIB is associated with decreased 30‐day rebleeding but increased 90‐day clinical vascular events compared with resumption ≤ 1 day post‐endoscopy. Similar tradeoffs were noted with antiplatelet resumption > 3 days post‐endoscopy. To optimise competing risks of rebleeding versus clinical vascular events, antiplatelet therapy should be resumed no later than 7 days post‐endoscopy, and preferably within 3–4 days.
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Li et al. (2026) conducted a cohort in Gastrointestinal bleeding after percutaneous coronary intervention (n=3,848). Antiplatelet resumption > 7 days post-endoscopy vs. Antiplatelet resumption ≤ 1 day post-endoscopy was evaluated on 30-day rebleeding and 90-day clinical vascular events after endoscopy (HR 0.66 (rebleeding), HR 1.18 (vascular events), 95% CI 0.49-0.87 (rebleeding), 1.02-1.36 (vascular events)). Resuming antiplatelets >7 days post-endoscopy in post-PCI GIB decreased 30-day rebleeding (HR 0.66; 95% CI 0.49-0.87) but increased 90-day vascular events (HR 1.18; 95% CI 1.02-1.36).
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