Key result
Antiplatelet and anticoagulant exposures are linked to higher 28-day mortality and rebleeding in GI bleeding.
Why the study?
Antiplatelet and anticoagulant therapies are widely used for cardiovascular and thromboembolic prevention, but they may complicate the management of gastrointestinal bleeding. Comparing patients receiving these therapies with those receiving neither helps describe differences in clinical profiles, management strategies, and outcomes.
Does exposure to antiplatelet or anticoagulant therapy affect 28-day mortality and rebleeding in patients presenting with gastrointestinal bleeding?
Cohort (n=5,000)
No
Does exposure to antiplatelet or anticoagulant therapy affect 28-day mortality and rebleeding in patients presenting with gastrointestinal bleeding?
In patients presenting with gastrointestinal bleeding, prior exposure to antiplatelet or anticoagulant therapy, along with age, chronic kidney disease, and markers of hemodynamic instability, is associated with increased 28-day all-cause mortality.
Antiplatelet or anticoagulant exposure was associated with higher 28-day mortality in GI bleeding; this observational link leaves open optimal management strategies.
Background: Gastrointestinal bleeding (GIB) is a clinically important cause of emergency assessment and hospitalization. Antiplatelet and anticoagulant therapies are widely used for cardiovascular and thromboembolic prevention but may complicate the management of bleeding. Comparing patients receiving these therapies with patients receiving neither can help describe differences in clinical profiles, management, and outcomes. Objective: To compare the clinical characteristics, management strategies, and outcomes of patients with GIB according to antiplatelet and anticoagulant medication exposure, and to examine factors associated with 28-day all-cause mortality. Methods: A retrospective observational cohort study was conducted at a tertiary care hospital in India from 1 February 2023 through 1 February 2026. The study included 5,000 records: 3,850 patients receiving neither antiplatelet nor anticoagulant therapy, 1,000 receiving antiplatelet therapy, and 150 receiving anticoagulant therapy. Medication exposure and clinical outcomes were abstracted from medical records. Results: The mean age was 57.9 ± 16.6 years, and 32.0% of patients were female. Peptic ulcer disease was the most frequently reported diagnosis (52.7%). Hypertension was more frequent in the antiplatelet group than in the reference group (79.4% vs 32.9%). Rebleeding within 28 days occurred in 486 patients (9.7%), and 28-day all-cause mortality occurred in 192 patients (3.8%). The reported multivariable analysis identified antiplatelet exposure, anticoagulant exposure, age, chronic kidney disease, low hemoglobin, low systolic blood pressure, and elevated lactate as factors associated with 28-day mortality. Conclusion: In this retrospective cohort, clinical characteristics, management, and outcomes differed across the reported medication-exposure groups. The findings describe associations and should not be interpreted as evidence of causation.
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Hossain et al. (2026) conducted a cohort in Gastrointestinal bleeding (n=5,000). Antiplatelet or anticoagulant therapy vs. Neither antiplatelet nor anticoagulant therapy was evaluated on 28-day all-cause mortality. Antiplatelet and anticoagulant exposures were independently associated with 28-day mortality (3.8% overall) and rebleeding (9.7% overall) in patients with gastrointestinal bleeding.
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