Yavuz ÖZDEN, Serdar DURAK
Eastern Journal of Medicine (EJM) - 2026;31(4):865-873
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. 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. 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). 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.
