Key result
Resuming antiplatelet therapy after GI bleeding cuts major vascular events ~30% despite increased recurrent bleeding.
Why the study?
Following gastrointestinal bleeding in patients receiving antithrombotics, resuming therapy risks rebleeding while discontinuation increases thrombotic events and mortality; quantifying these risks, benefits, and optimal resumption timing remained an open dilemma.
Does the resumption of antithrombotic therapy reduce major vascular events and mortality in patients following gastrointestinal bleeding?
Meta-Analysis
Does the resumption of antithrombotic therapy reduce major vascular events and mortality in patients following gastrointestinal bleeding?
Resumption of antithrombotic therapy after gastrointestinal bleeding, particularly within 7 days, offers a favorable benefit-risk balance by significantly reducing major vascular events and mortality despite an increased risk of recurrent bleeding.
Answers are grounded in this paper and cite their sources.
Supports resuming antiplatelet or anticoagulant therapy ≤7 days after GIB to cut vascular events and mortality; extends timing evidence despite higher rebleeding risk.
BACKGROUND AND AIMS: Gastrointestinal bleeding (GIB) is a major complication in patients receiving antithrombotic therapy. Following GIB, clinicians face a critical dilemma: resuming therapy risks rebleeding, while discontinuation increases thrombotic events and mortality. This meta-analysis aimed to quantify the risks and benefits of antithrombotic therapy resumption versus discontinuation following GIB, and to evaluate the impact of resumption timing on recurrent GIB, major vascular events, and all-cause mortality. METHODS: We searched Embase, Scopus, PubMed, Web of Science, and Cochrane Library from inception to September 2025 for studies comparing antithrombotic therapy resumption versus delayed resumption or discontinuation after GIB. This review was registered with PROSPERO (CRD420251141360). RESULTS: Twenty-one studies were included. Antiplatelet therapy (APT) resumption reduced major vascular events (HR 0.70, 95% CI 0.60-0.83; absolute risk difference [ARD] -3.6%) and mortality (HR 0.44, 95% CI 0.26-0.76; ARD -10.0%), but increased recurrent GIB (HR 1.42, 95% CI 1.09-1.84; ARD +2.2%). Similarly, anticoagulant therapy (ACT) resumption reduced major vascular events (HR 0.45, 95% CI 0.34-0.58; ARD -7.0%) and mortality (HR 0.53, 95% CI 0.43-0.65; ARD -11.1%), but increased recurrent GIB (HR 1.59, 95% CI 1.38-1.83; ARD +2.6%). Notably, early resumption of both APT and ACT within 7 days significantly reduced major vascular events (HR 0.39, 95% CI 0.19-0.78; ARD -11.4%) but increased recurrent GIB (HR 1.49, 95% CI 1.18-1.89; ARD +2.7%), with no significant difference in mortality (HR 0.78, 95% CI 0.29-2.10; ARD -4.7%). CONCLUSION: Both APT and ACT resumption after GIB provide substantial clinical benefits despite increased recurrent GIB risk. Early resumption (≤7 days) offers favorable benefit-risk balance.
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Liu et al. (2026) conducted a meta-analysis in Gastrointestinal bleeding in patients receiving antithrombotic therapy. Antithrombotic therapy resumption vs. Delayed resumption or discontinuation was evaluated on Major vascular events (antiplatelet therapy resumption) (HR 0.70, 95% CI 0.60-0.83). Resumption of antiplatelet therapy after gastrointestinal bleeding reduced major vascular events and mortality, despite increased recurrent bleeding.
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