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

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ABSTRACT Background 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. Methods 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. Results 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; p = 0.027) and less need for therapy (38.5% vs. 48.1%;p = 0.002), with gastric erosion being more usual (14.2% vs. 9.1%; p = 0.006). In-hospital mortality was higher in patients not taking antithrombotic (12% vs. 8%;p = 0.022) and suspension < 72 h was associated with increased mortality (14.9% vs. 2.3%;p = 0.001). Delayed mortality was higher in patients taking antithrombotic (9.4% vs. 6%; p=0.034) and in those who suspended them for more than 7days (17% vs. 8.7%; p=0.033), with no differences when it lasted<72h. Patients on antithrombotic therapy exhibited more delayed cardiovascular (13.7% vs. 3.4%; p<0.0001) and hemorrhagic events (22.9% vs. 12.9%; p<0.0001), with no differences observed in patients who withheld antithrombotic medication. Multivariate analysis identified ASA, disseminated malignancy, and NSAIDs as independent risk factors for in-hospital mortality, whereas antithrombotic therapy and hemoglobin levels were protective factors. Conclusion Patients with upper gastrointestinal bleeding treated with antithrombotic drugs had lower in-hospital mortality despite increased comorbidities and older age. Conversely, delayed 6-month mortality was higher. Shorter antithrombotic suspension durations increased in-hospital mortality, whereas suspension for > 7 days increased delayed mortality.