title: When Should Antiplatelet Agents Be Resumed After Successful Endoscopic Hemostasis in Patients with Peptic Ulcer Bleeding?
abstract: During treatment for peptic ulcer bleeding (PUB), it is imperative to determine the effect of antiplatelet agents on recurrent bleeding in order to balance risks and benefits.
  
  
  
  We compared the rate of recurrent bleeding in antiplatelet users and non-users.
  
  
  
  This retrospective study analyzed prospectively collected data from PUB patients treated by endoscopic modalities between August 2007 and December 2014. We evaluated and compared the rate of recurrent bleeding within 30 days in antiplatelet users and non-users; we also categorized antiplatelet users into continuation (≤3 days) and withdrawal (>3 days) groups.
  
  
  
  A total of 490 patients were enrolled in the study, 302 (61.6 %) and 188 (38.4 %) in the non-user and antiplatelet user groups, respectively. The recurrent bleeding rate among antiplatelet users (10.1 %) was significantly higher than that among non-users (5.0 %; p = 0.029). Among 188 antiplatelet users, 51 (27.1 %) and 137 (72.9 %) were assigned to the continuation and withdrawal groups, respectively. The rate of recurrent bleeding did not differ significantly between groups (11.7 vs. 5.9 %, p = 0.241). Multivariate analysis revealed chronic kidney disease as a risk factor [odds ratio (OR) 2.890, 95 % confidence interval (CI) 1.079-7.742, p = 0.035]. However, antiplatelet use (OR 1.691, 95 % CI 0.813-3.517, p = 0.160) was not.
  
  
  
  This study highlights the need for clinicians to consider underlying diseases in antiplatelet users under the appropriate antiplatelet therapy during the post-hemostasis period. Furthermore, the optimal time to resume antiplatelet agents may be 3 days after successful endoscopic hemostasis in patients with PUB.
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
authors: Jung-Wook
authors: JW
authors: Kim
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
authors: Hyun Jin
authors: HJ
authors: Park
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea. jyjang@khu.ac.kr.
authors: Jae-Young
authors: JY
authors: Jang
authors: Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
authors: Chi Hyuk
authors: CH
authors: Oh
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
authors: Jae-Jun
authors: JJ
authors: Shim
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
authors: Chang Kyun
authors: CK
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
authors: Young Woon
authors: YW
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet agents; Gastrointestinal bleeding; Peptic ulcer disease; Thromboembolism