Introduction
Restarting anticoagulation (AC) therapy following acute gastrointestinal bleeding (GIB) is a multidisciplinary, personalized decision. Current guidelines recommend resuming AC, though data on the optimal timing is limited.
Aims & Methods
Our aim is to assess the short-term effect of early and delayed AC therapy resumption.
We analyzed the data of the Hungarian GIB Registry (a multicenter, prospective database) between 2019-2022. Patients were included after successful management of AC-related GIB. Detailed medical and drug history, demographics, and data on the index bleeding and management (bleeding source, endoscopic, and medical therapy) were collected. 30 and 90-day rebleeding, thromboembolic (TE) complications, all-cause, and 30-day recurrent GIB or TE-related mortality were assessed in the early (≤ 7 days) and delayed (>7 days) AC resumption groups.
Results
218 cases were analyzed. Except for the CHA2Ds2-VASc score (mean (SD) 5.19 (1.65) vs 4.37 (1.549); p=0.02), the main characteristics (e.g., age, Charlson comorbidity index, active malignancy, anamnestic previous GIB, co-medications, HAS-BLED score, hemodynamic instability, high-risk bleeding site, endoscopic intervention) were similar between the two groups. Delayed AC therapy resumption was not associated with decreased 30-day rebleeding risk (5.3% vs. 6.7%; HR = 1.26, 95%CI 0.27-5.77, p=0.76). Delayed resumption was not associated with a higher 90-day TE complications rate (2.1% vs. 6.6%; HR = 3.17, 95%CI 0.58-17.33, p=0.18). Recurrent GIB-related 30-day mortality occurred only in one case (early resumption group, 12 days after admission with index bleeding). TE-related mortality was not observed during the follow-up.
Conclusion
Anticoagulation resumption in the first seven days after GIB was proven to be safe, which supports the suggestion of the actual European guidelines. Further research on separated bleeding sources and types of anticoagulants is needed.
Disclosure
Authors do not have any conflict of interest to disclose.