Key result
Antithrombotic therapy in upper GI bleeding is linked to lower in-hospital but higher 6-month mortality.
Why the study?
Antithrombotic drugs create a dual challenge in acute upper gastrointestinal bleeding due to bleeding risks and subsequent thromboembolic risks upon withdrawal, leaving the impact of suspension and resumption on mortality unclear.
Does antithrombotic treatment and its suspension duration affect in-hospital and delayed mortality in patients with upper gastrointestinal bleeding?
Observational
Does antithrombotic treatment and its suspension duration affect in-hospital and delayed mortality in patients with upper gastrointestinal bleeding?
In patients with upper gastrointestinal bleeding, suspending antithrombotic therapy for more than 7 days increases delayed mortality, highlighting the need for careful timing of resumption.
Prolonged antithrombotic suspension after upper GI bleed may raise delayed mortality; leaves open optimal resumption timing for prospective trials.
BACKGROUND: Antithrombotic drugs pose a dual challenge to acute upper gastrointestinal bleeding, with associated risks of bleeding complications and thromboembolic events upon withdrawal. We aimed to determine the impact of antithrombotic medications on in-hospital and delayed outcomes and whether suspension and resumption influenced delayed mortality. METHODS: This study was a prospective registry analysis of patients between 2013-2021. Anticoagulants and antiplatelets were classified as antithrombotic. The examined outcomes included in-hospital mortality and delayed 6-month cardiovascular, bleeding, and mortality events. RESULTS: <0.0001), with no differences observed in patients who withheld antithrombotic medication.Multivariate analysis identified ASA, disseminated malignancy, and NSAIDs as independent risk factors for in-hospital mortality, whereas antithrombotic therapy and hemoglobin levels were protective factors. CONCLUSION: Patients with upper gastrointestinal bleeding treated with antithrombotic drugs had lower in-hospital mortality despite increased comorbidities and older age. Conversely, delayed 6-month mortality was higher. Shorter antithrombotic suspension durations increased in-hospital mortality, whereas suspension for > 7 days increased delayed mortality.
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Redondo‐Cerezo et al. (2024) conducted an observational in Upper gastrointestinal bleeding. Antithrombotic therapy withdrawal and resumption vs. No antithrombotic therapy / different suspension durations was evaluated on In-hospital mortality and delayed 6-month cardiovascular, bleeding, and mortality events (p=<0.0001). Antithrombotic therapy in upper gastrointestinal bleeding was associated with lower in-hospital mortality but higher 6-month mortality, while suspension >7 days increased delayed mortality.
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