In-hospital and delayed mortality in patients with upper gastrointestinal bleeding on antithrombotic treatment: effects of withdrawal and resuming

• Published in: Postgraduate medicine 2024-12, Vol.137 (1), p.1-53
• Main Authors: Redondo-Cerezo, Eduardo, Fernandez-García, Raúl, López Vico, Manuel, Ortega-Suazo, Eva Julissa, Tendero-Peinado, Cristina, López-Tobaruela, Jose María, Lancho, Ana, Valverde-López, Francisco, Martínez-Cara, Juan Gabriel, Jiménez-Rosales, Rita
• Format: Article
• Language: English
• ISSN: 0032-5481; 1941-9260; 1941-9260
• DOI: 10.1080/00325481.2024.2436840

Antithrombotic drugs pose a dual challenge to acute upper gastrointestinal bleeding, with associated risks of bleeding complications and thromboembolic events upon withdrawal. We aimed to determine the impact of antithrombotic medications on in-hospital and delayed outcomes and whether suspension and resumption influenced delayed mortality. This study was a prospective registry analysis of patients between 2013-2021. Anticoagulants and antiplatelets were classified as antithrombotic. The examined outcomes included in-hospital mortality and delayed 6-month cardiovascular, bleeding, and mortality events. A total of 1345 patients were included. 21.7% were taking anticoagulants and 19.1% were taking antiplatelets. Patients on antithrombotic therapy have a longer delay in endoscopic performance (11 ± 11 h vs. 9.6 ± 8 h;  = 0.027) and less need for therapy (38.5% vs. 48.1%;  = 0.002), with gastric erosion being more usual (14.2% vs. 9.1%;  = 0.006).In-hospital mortality was higher in patients not taking antithrombotic (12% vs. 8%;  = 0.022) and suspension