This systematic review and meta-analysis (21 studies, PROSPERO-registered) evaluated the risks and benefits of resuming antiplatelet therapy (APT) or anticoagulant therapy (ACT) versus discontinuation after gastrointestinal bleeding (GIB), and examined whether timing of resumption (early ≤7 days vs. later) affected recurrent GIB, major vascular events, and all-cause mortality.
APT resumption reduced major vascular events (HR 0.70; ARD −3.6%) and mortality (HR 0.44; ARD −10.0%) but raised recurrent GIB risk (HR 1.42; ARD +2.2%). ACT resumption similarly cut major vascular events (HR 0.45; ARD −7.0%) and mortality (HR 0.53; ARD −11.1%) with a modest rebleeding increase (HR 1.59; ARD +2.6%). Early resumption (≤7 days) further reduced major vascular events (HR 0.39; ARD −11.4%) at the cost of a small rebleeding increase (ARD +2.7%), with no significant mortality difference.
- Most included studies were observational, introducing residual confounding by indication (sicker patients more likely to have therapy withheld). - Timing cutoffs and definitions of 'early' vs. 'late' resumption varied across studies. - Heterogeneity in GIB source, severity, and antithrombotic indication limits generalizability.
For most patients on antithrombotic therapy who experience GIB, resuming therapy — ideally within 7 days — offers a net clinical benefit: large reductions in thrombotic events and death outweigh a small absolute increase in rebleeding risk (~2–3%). Individualize timing based on bleeding severity and thrombotic risk.
