Key result
Early antithrombotic resumption linked to ~39% lower 30-day ischemic risk but increases recurrent bleeding.
Why the study?
The optimal timing of antithrombotic resumption after acute gastrointestinal bleeding remains uncertain because delayed resumption may increase ischemic risk whereas early resumption may precipitate recurrent bleeding.
Does early (≤7 days), late (>15 days), or non-resumption of antithrombotic therapy compared with intermediate resumption (8-15 days) affect 30-day ischemic cardiovascular events and recurrent gastrointestinal bleeding in adults hospitalized with acute gastrointestinal bleeding?
Cohort (n=1,448)
No
Does early (≤7 days), late (>15 days), or non-resumption of antithrombotic therapy compared with intermediate resumption (8-15 days) affect 30-day ischemic cardiovascular events and recurrent gastrointestinal bleeding in adults hospitalized with acute gastrointestinal bleeding?
After acute gastrointestinal bleeding, resuming antithrombotic therapy within an intermediate window of 8 to 15 days provides the most favorable balance between competing 30-day risks of ischemic cardiovascular events and recurrent hemorrhage.
Answers are grounded in this paper and cite their sources.
Early resumption after GI bleed was associated with fewer ischemic events but more bleeding; leaves open optimal timing in prospective trials.
The optimal timing of antithrombotic resumption after acute gastrointestinal bleeding remains uncertain, as delayed resumption may increase ischemic risk whereas early resumption may precipitate recurrent bleeding.This study evaluated 30-day ischemic and bleeding risks according to antithrombotic resumption timing after gastrointestinal bleeding.This retrospective single-center cohort study included 1,448 adults hospitalized with acute gastrointestinal bleeding while receiving antithrombotic therapy between January 2021 and December 2025.Patients were categorized as early (≤7 days), intermediate (8-15 days), late (>15 days), or not resumed within 30 days.The primary outcome was 30-day ischemic cardiovascular events; secondary outcomes included recurrent gastrointestinal bleeding, all-cause mortality, and hospital readmission.Cox regression, landmark analysis at day 7, and continuous-time analysis were performed.Early resumption occurred in 486 patients (33.6%), intermediate resumption in 412 (28.5%), late resumption in 298 (20.6%), and no resumption within 30 days in 252 (17.4%).Compared with intermediate resumption, early resumption was associated with lower ischemic risk (adjusted HR 0.61; 95% CI 0.42-0.89)but higher recurrent bleeding risk (adjusted HR 2.18; 95% CI 1.47-3.24).Nonresumption was associated with higher ischemic risk (adjusted HR 2.84; 95% CI 1.92-4.21)and all-cause mortality (adjusted HR 2.67; 95% CI 1.71-4.16).Antithrombotic resumption timing was associated with competing 30-day ischemic and bleeding risks.An intermediate window of 8-15 days showed the most favorable short-term balance, supporting individualized, risk-adapted decision-making.
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Özden et al. (2026) conducted a cohort in Acute gastrointestinal bleeding in patients receiving antithrombotic therapy (n=1,448). Early antithrombotic resumption (≤7 days) vs. Intermediate antithrombotic resumption (8–15 days) was evaluated on Composite of 30-day ischemic cardiovascular events (nonfatal myocardial infarction, nonfatal ischemic stroke, cardiovascular death, urgent revascularization for stent thrombosis, or systemic thromboembolism) (adjusted HR 0.61, 95% CI 0.42-0.89, p=0.009). Early antithrombotic resumption (≤7 days) reduced 30-day ischemic events (adjusted HR 0.61, 95% CI 0.42–0.89) but increased recurrent bleeding (HR 2.18) vs intermediate resumption (8–15 days).
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