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Re-starting anticoagulation and antiplatelets after gastrointestinal bleeding: A systematic review
Ethan Slouha1, Haley Jensen1, Hope Fozo1
1St George's University School of Medicine, Saint George's, Saint George, Grenada.
Insights
Resuming anticoagulation after gastrointestinal bleeds (GIB) is crucial. The optimal time to restart therapy is 15-30 days post-GIB to prevent thrombotic events.
Area of Science:
- Gastroenterology
- Cardiology
- Internal Medicine
Background:
- Gastrointestinal bleeds (GIB) cause significant mortality, with upper GIB leading to 20,000 US deaths annually.
- Patients on antithrombotics have a 4% GIB risk, complicating treatment decisions.
- Risk stratification is vital for managing patients after GIB, especially regarding antithrombotic therapy.
Purpose of the Study:
- To systematically review and assess general trends in the timing of resuming anticoagulation after upper gastrointestinal bleeds.
- To inform clinical decision-making for patients requiring antithrombotic therapy post-GIB.
Main Methods:
- A systematic literature search was conducted across PubMed, ScienceDirect, and ProQuest by three independent reviewers.
- Articles were screened using specific inclusion and exclusion criteria.
- A total of 11,769 articles were initially identified, with 22 ultimately included in the review.
Main Results:
- Resuming anticoagulation after GIB is associated with a reduced risk of thrombotic events.
- The optimal time frame for resuming anticoagulant therapy was identified as 15-30 days following the GIB.
- Delaying anticoagulation increases the risk of thromboembolic complications.
Conclusions:
- The decision to resume anticoagulation post-GIB requires careful consideration of individual patient factors and medical history.
- Resuming therapy within the 15-30 day window is recommended to balance bleeding and thrombotic risks.
- This systematic review provides evidence-based guidance for managing anticoagulation in patients with a history of upper GIB.
Abstract:
Background: Gastrointestinal bleeds (GIB) are associated with high morbidity and mortality, with upper GIB accounting for 20,000 deaths annually in the United States of America. Accurate risk stratification is essential in determining and differentiating high-risk versus low-risk patients, as low-risk patients have an overall better prognosis. Patients taking antithrombotics to reduce the risk of thromboembolic events have a 4% chance of developing a GIB. This then places physicians in a difficult position as they must perform a risk-and-benefit analysis of whether to reinstate antithrombotics after a major GIB. This systematic review aims to assess the general trends in time for resuming anticoagulation in the setting of upper GI bleed. Methods: A literary search of three different databases was performed by three independent reviewers. The research databases included PubMed, ScienceDirect, and ProQuest. Specific keywords were used to narrow the search and articles were screened based on inclusion and exclusion criteria. Results: Our initial search generated 11,769 potential articles and 22 articles were ultimately used for this review using specific inclusion and exclusion criteria. There is an increase in thrombotic events following a GIB if anticoagulants are not resumed. We also found that the best time to resume therapy was 15-30 days post-GIB. Conclusions: Therefore, the decision to resume anticoagulation therapy should consider the patients' medical history and should fall within 15-30 days post-GIB.
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