Antithrombotic Resumption After Gastrointestinal Bleeding: 30-Day Outcomes

INTRODUCTION: The optimal timing of antithrombotic resumption after acute gastrointestinal bleeding remains uncertain, as delayed resumption may increase ischemic risk whereas early resumption may precipitate recurrent bleeding. This study evaluated 30-day ischemic and bleeding risks according to antithrombotic resumption timing after gastrointestinal bleeding.
METHODS: This retrospective single-center cohort study included 1,448 adults hospitalized with acute gastrointestinal bleeding while receiving antithrombotic therapy between January 2021 and December 2025. Patients were categorized as early (≤7 days), intermediate (8–15 days), late (>15 days), or not resumed within 30 days. The primary outcome was 30-day ischemic cardiovascular events; secondary outcomes included recurrent gastrointestinal bleeding, all-cause mortality, and hospital readmission. Cox regression, landmark analysis at day 7, and continuous-time analysis were performed.
RESULTS: Early resumption occurred in 486 patients (33.6%), intermediate resumption in 412 (28.5%), late resumption in 298 (20.6%), and no resumption within 30 days in 252 (17.4%). Compared with intermediate resumption, early resumption was associated with lower ischemic risk (adjusted HR 0.61; 95% CI 0.42–0.89) but higher recurrent bleeding risk (adjusted HR 2.18; 95% CI 1.47–3.24). Non-resumption was associated with higher ischemic risk (adjusted HR 2.84; 95% CI 1.92–4.21) and all-cause mortality (adjusted HR 2.67; 95% CI 1.71–4.16).
DISCUSSION AND CONCLUSION: Antithrombotic resumption timing was associated with competing 30-day ischemic and bleeding risks. An intermediate window of 8–15 days showed the most favorable short-term balance, supporting individualized, risk-adapted decision-making.

Keywords: Gastrointestinal bleeding, anticoagulants, antiplatelet therapy, thromboembolism, risk assessment.