Antiplatelet Resumption Timing in Post-Percutaneous Coronary Intervention Gastrointestinal Bleeding

Antiplatelet management in patients hospitalised for gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) requires balancing risks of rebleeding and clinical vascular events.

Evaluate the impact of antiplatelet resumption timing post-endoscopy on rebleeding and clinical vascular events.

We performed a retrospective nationwide cohort study of patients hospitalised with post-PCI GIB on dual antiplatelet therapy (DAPT) using the Vizient Clinical Database. Co-primary outcomes were 30-day rebleeding and 90-day clinical vascular events after endoscopy. Multivariable Cox proportional hazards regression analysis was performed.

Among 2979 patients with both antiplatelet agents held before endoscopy for GIB (46.0% upper; 34.8% lower), antiplatelet resumption > 7 days post-endoscopy was associated with decreased 30-day rebleeding (hazard ratio [HR] 0.66; 95% confidence interval [CI] [0.49-0.87]) and increased 90-day clinical vascular events (HR 1.18 [1.02-1.36]) compared to restarting ≤ 1 day post-endoscopy. Among 869 patients with one antiplatelet agent held before endoscopy for GIB (47.3% upper; 36.3% lower), resumption at > 7 days vs. ≤ 1 day had HR 0.69 (0.41-1.14) for rebleeding and HR 1.41 (0.97-2.04) for clinical vascular events. HRs for antiplatelet resumption > 3 days vs. ≤ 1 day post-endoscopy were similar.

Antiplatelet resumption > 7 days after endoscopy in patients hospitalised with post-PCI GIB is associated with decreased 30-day rebleeding but increased 90-day clinical vascular events compared with resumption ≤ 1 day post-endoscopy. Similar tradeoffs were noted with antiplatelet resumption > 3 days post-endoscopy. To optimise competing risks of rebleeding versus clinical vascular events, antiplatelet therapy should be resumed no later than 7 days post-endoscopy, and preferably within 3-4 days.