Antiplatelet Resumption Timing in Post‐Percutaneous Coronary Intervention Gastrointestinal Bleeding

BACKGROUND: Antiplatelet management in patients hospitalised for gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) requires balancing risks of rebleeding and clinical vascular events. AIMS: Evaluate the impact of antiplatelet resumption timing post-endoscopy on rebleeding and clinical vascular events. METHODS: We performed a retrospective nationwide cohort study of patients hospitalised with post-PCI GIB on dual antiplatelet therapy (DAPT) using the Vizient Clinical Database. Co-primary outcomes were 30-day rebleeding and 90-day clinical vascular events after endoscopy. Multivariable Cox proportional hazards regression analysis was performed. RESULTS: Among 2979 patients with both antiplatelet agents held before endoscopy for GIB (46.0% upper; 34.8% lower), antiplatelet resumption > 7 days post-endoscopy was associated with decreased 30-day rebleeding (hazard ratio [HR] 0.66; 95% confidence interval [CI] [0.49-0.87]) and increased 90-day clinical vascular events (HR 1.18 [1.02-1.36]) compared to restarting ≤ 1 day post-endoscopy. Among 869 patients with one antiplatelet agent held before endoscopy for GIB (47.3% upper; 36.3% lower), resumption at > 7 days vs. ≤ 1 day had HR 0.69 (0.41-1.14) for rebleeding and HR 1.41 (0.97-2.04) for clinical vascular events. HRs for antiplatelet resumption > 3 days vs. ≤ 1 day post-endoscopy were similar. CONCLUSIONS: Antiplatelet resumption > 7 days after endoscopy in patients hospitalised with post-PCI GIB is associated with decreased 30-day rebleeding but increased 90-day clinical vascular events compared with resumption ≤ 1 day post-endoscopy. Similar tradeoffs were noted with antiplatelet resumption > 3 days post-endoscopy. To optimise competing risks of rebleeding versus clinical vascular events, antiplatelet therapy should be resumed no later than 7 days post-endoscopy, and preferably within 3-4 days.