Key result
Continuing aspirin and restarting clopidogrel at 7 days after upper gastrointestinal hemorrhage minimized rebleeding and cardiovascular events while yielding the lowest mortality.
Why the study?
The optimum time to reintroduce original antiplatelet drugs after upper gastrointestinal hemorrhage in patients receiving secondary prevention for cardiovascular and cerebrovascular diseases was unknown.
Does the timing of resumption of antiplatelet drugs affect rebleeding, cardiovascular events, and mortality in patients after upper gastrointestinal hemorrhage?
RCT
Randomly divided
Does the timing of resumption of antiplatelet drugs affect rebleeding, cardiovascular events, and mortality in patients after upper gastrointestinal hemorrhage?
After upper gastrointestinal bleeding in patients on dual antiplatelet therapy, continuing aspirin without interruption and restarting clopidogrel at 7 days optimizes the balance between rebleeding and cardiovascular events.
Supports immediate aspirin continuation and clopidogrel resumption at 7 days post-UGIB; extends RCT evidence for optimal DAPT timing.
BACKGROUND This study aimed to investigate the optimum time to reintroduce the original antiplatelet drugs after upper gastrointestinal hemorrhage in patients as secondary prevention for cardiovascular and cerebrovascular diseases. MATERIAL AND METHODS After the upper gastrointestinal bleeding stopped, patients were randomly divided according to the oral antiplatelet drugs administered. The aspirin group was further divided into 3-day and 7-day aspirin groups. The patients who took aspirin and clopidogrel were randomly divided into 3 groups: 0-day aspirin+3-day clopidogrel; 0-day aspirin+7-day clopidogrel; and 3-day aspirin+7-day clopidogrel. The recovery time, rebleeding rate, incidence of cardiovascular and cerebrovascular events, and death were observed. RESULTS The 3-day aspirin group had more rebleeding, reduced risk of cardiovascular and cerebrovascular events, and a similar mortality rate compared to the other groups. In the aspirin+clopidogrel group, the 0-day aspirin+3-day clopidogrel group had the highest rebleeding rate and the lowest risk of cardiovascular and cerebrovascular events. The 3-day aspirin+7-day clopidogrel group had the highest risk of cardiovascular and cerebrovascular events and increased hospitalization time. The risk of rebleeding and cardiovascular and cerebrovascular events was lower in the 0-day aspirin+7-day clopidogrel group, and the overall mortality rate was the lowest in this group. CONCLUSIONS In patients receiving only aspirin, this drug should be reintroduced as soon as possible after peptic ulcer hemorrhage. Aspirin and clopidogrel are dual antiplatelet drugs used for the secondary prevention of cardiovascular diseases. In patients under dual-drug therapy, aspirin should not be stopped, while clopidogrel should be restarted in about 7 days.
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Ma et al. (2022) conducted an RCT in Upper gastrointestinal hemorrhage. Early resumption of antiplatelet drugs vs. Delayed resumption of antiplatelet drugs was evaluated on Rebleeding rate, cardiovascular and cerebrovascular events, and death. Continuing aspirin and restarting clopidogrel at 7 days after upper gastrointestinal hemorrhage minimized rebleeding and cardiovascular events while yielding the lowest mortality.
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