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Antiplatelet Resumption Timing in Post-Percutaneous Coronary Intervention Gastrointestinal Bleeding

Darrick K Li1, Yuan Pu1, Yihang Liu2

  • 1Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Alimentary Pharmacology & Therapeutics
|March 19, 2026
PubMed

Insights

Resuming antiplatelet therapy more than 7 days after endoscopy for gastrointestinal bleeding (GIB) post-percutaneous coronary intervention (PCI) reduces rebleeding but increases vascular events. Optimal timing balances these risks, suggesting resumption within 3-4 days.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Clinical Pharmacology

Background:

  • Managing antiplatelet therapy in patients with gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) involves balancing rebleeding risk against clinical vascular events.
  • Dual antiplatelet therapy (DAPT) is standard post-PCI, but increases bleeding risk during GIB events.

Purpose of the Study:

  • To evaluate the impact of the timing of antiplatelet resumption after endoscopic treatment on GIB recurrence and clinical vascular events.
  • To determine the optimal window for resuming antiplatelet therapy to minimize adverse outcomes.

Main Methods:

  • A retrospective nationwide cohort study was conducted using the Vizient Clinical Database.
  • Patients hospitalized with GIB after PCI and on DAPT were analyzed.
  • Co-primary outcomes included 30-day rebleeding and 90-day clinical vascular events, assessed via multivariable Cox regression.

Main Results:

  • Resuming antiplatelet therapy more than 7 days post-endoscopy was linked to lower rebleeding rates (HR 0.66) but higher vascular event rates (HR 1.18) compared to resumption within 1 day.
  • Similar trade-offs were observed for resuming therapy more than 3 days post-endoscopy.
  • These trends were consistent across upper and lower GIB presentations.

Conclusions:

  • Delaying antiplatelet resumption beyond 7 days post-endoscopy for GIB after PCI decreases rebleeding but increases vascular events.
  • Resumption within 3-4 days appears to offer the best balance between reducing rebleeding and preventing clinical vascular events.
  • Personalized antiplatelet management is crucial to optimize outcomes in this high-risk patient population.
Abstract

Keywords:
antiplateletclinical vascular eventsgastrointestinal bleedingpercutaneous coronary intervention

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