Management of antithrombotic agents during emergency endoscopy for upper gastrointestinal bleeding: A propensity score matching analysis

Abstract Background In this study, we compared the outcomes of upper gastrointestinal bleeding (UGIB) during emergency endoscopy between patients taking and not taking antithrombotic agents to inform antithrombotic management. Patients and Methods We conducted a retrospective analysis of 389 patients who underwent emergency endoscopy for UGIB at Ureshino Medical Center from 2016 to 2021. The patients were categorized into Group A (taking antithrombotic agents) and Group NA (not taking antithrombotic agents). The clinical characteristics, types of antithrombotic agent, patient status on admission, and UGIB etiology were evaluated. Treatment outcomes and adverse events were assessed by propensity score matching (PSM). Results Group A was significantly older and had a higher prevalence of cardiovascular and cerebrovascular diseases. The primary antithrombotic agent was low-dose aspirin, with multiple antithrombotics taken by 38 patients (29.0%). Peptic ulcers were the most common cause of UGIB in both groups. PSM generated 83 matched pairs. The success rate of endoscopic hemostasis was significantly higher in Group A than in Group NA (96.4% vs. 84.3%, P = 0.02). Soft coagulation as a hemostatic technique was significantly more frequently used in Group A than in Group NA (57.8% vs. 39.8%, P = 0.04). Despite promptly resuming antithrombotic agents post-hemostasis, there was no significant difference in the rebleeding rate or 30-day mortality. Conclusion This study demonstrated a higher endoscopic hemostasis success rate in patients undergoing antithrombotic therapy. No differences in rebleeding or 30-day mortality post-hemostasis were observed. Consequently, the prompt resumption of antithrombotic agents after emergency endoscopy for UGIB was acceptable.