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Impact of antithrombotic therapy resumption in patients with gastrointestinal bleeding: a multicenter retrospective

Ding Peng1, Huihong Zhai1

  • 1Department of Gastroenterology, Xuanwu Hospital Capital Medical University, Changchun Street 45#, 100053 Beijing, China.

Therapeutic Advances in Gastroenterology
|June 11, 2025
PubMed

Insights

Antithrombotic therapy for gastrointestinal bleeding reduces 28-day mortality but significantly increases rebleeding risk. Early resumption of these therapies may also elevate mortality risk.

Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Pharmacology

Background:

  • Gastrointestinal bleeding (GIB) is a serious condition with high mortality.
  • Increased use of antithrombotic agents (antiplatelets, anticoagulants) correlates with rising GIB incidence.

Purpose of the Study:

  • To investigate the impact of antithrombotic therapy on 28-day mortality and rebleeding in GIB patients.
  • To compare risks associated with different antithrombotic agents and timing of resumption.

Main Methods:

  • Retrospective cohort study utilizing data from three independent databases (2008-2022).
  • Propensity score matching and inverse probability of treatment weighting (IPTW) to control for confounding factors.
  • Weighted logistic regression to analyze outcomes across antiplatelet, anticoagulant, and combination therapy subgroups.

Main Results:

  • Antithrombotic therapy was associated with a significantly lower 28-day mortality (8.2% vs 12.5%).
  • However, antithrombotic therapy significantly increased rebleeding rates (19.9% vs 10.5%) and risk (OR=2.118).
  • Anticoagulants or combination therapy showed the highest rebleeding risk; early resumption (within 3 days) increased mortality risk.

Conclusions:

  • Antithrombotic therapy presents a trade-off: reduced mortality but increased rebleeding risk in GIB.
  • Specific agents (anticoagulants, combination therapy) and early resumption timing require careful consideration due to elevated risks.
Abstract

Keywords:
28-day mortalityantithrombotic therapygastrointestinal bleedingrebleeding risk

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