The risks of Thromboembolism vs. recurrent GI bleeding after interruption of systemic anticoagulation.

Background: During hospitalization due to GI bleed anticoagulants are stopped until the episode is resolved. There are very few guidelines or data available on when and if anticoagulation should be restarted.

Design: A prospective study indicates that the answer is YES. 197 anticoagulated patients who presented with GIB. When discharged, anticoagulants were discontinued in 39%and was restarted in the others. They were followed for 90 d and information on thromboembolic event, GIB or death was obtained.

Results: 7 patients (4%) developed a thromboembolic event , in six anticoagulation had been discontinued. (95% CI) Hospitalization of GIB did not differ between groups. Malignancy was an independent risk factor for thromboembolism. Resumption of anticoagulation was not associated with 90d mortality.

Results of this study should be interpreted with caution, small number of patients and a very heterogeneous population with different indications for anticoagulation and causes of GI bleed were studied which can lead to errors. More well-controlled studies are needed.  In conclusion we should restart anticoagulation after a discussion with patients of potential consequences.