Presentation of gastrointestinal bleeding in patients with antithrombotic therapy, results from a consecutive retrospective cohort

Comprehensive Summary

This single-center, retrospective cohort study examined emergency department (ED) patients with gastrointestinal (GI) bleeding, comparing those on antithrombotic therapy to those not receiving such treatment. A consecutive cohort of 585 adult patients was stratified by therapy: aniplatelet, oral anticoagulant or no antithrombotics. Group comparisons were performed using nonparametric and regression analyses. Overall severity of bleeding across groups was similar, but patients on anticoagulants more often presented with isolated hematochezia and less frequently with hematemesis compared with those on antiplatelets or no therapy. No significant group differences were observed in hemoglobin levels at admission, shock index, and need for endoscopy or blood transfusion.

Outcomes and Implications

With the rising use of antithrombotic therapy, a growing proportion of patients with GI bleeding will present to the ED while on these medications. This may influence initial diagnostic priorities in the ED, such as early consideration of lower GI sources in patients receiving anticoagulants. While the study demonstrated differences in presentation of GI bleeding across groups, risk stratification, transfusion needs, and endoscopic management are similar regardless of antithrombotic status. Limitations include the study’s retrospective, single-center design and potential for missing data, which limit generalizability. Nonetheless, these findings provide practical insight for ED clinicians managing GI bleeding in patients on antithrombotics.