Does antithrombotic therapy at admission raise risk of in-hospital deaths in UGIB?

Use of antithrombotic agents at admission does not increase the risk of in-hospital mortality in patients with acute upper gastrointestinal bleeding (UGIB), according to a study, noting a protective trend overall and significant protection in antiplatelet users and nonvariceal bleeding.

Antithrombotic therapy at admission showed no significant association with increased in-hospital mortality, with a trend towards a protective association (odds ratio [OR], 0.79, 95 percent confidence interval [CI], 0.62‒1.01).

In subgroup analyses, antiplatelet agents conferred a significant protective effect (OR, 0.67, 95 percent CI, 0.47‒0.95), anticoagulant showed no significant impact (OR, 1.09, 95 percent CI, 0.72‒1.64), and mortality was significantly reduced in studies restricted to nonvariceal bleeding (OR, 0.60, 95 percent CI, 0.41‒0.87).

“Given the observational design, findings should be interpreted as a prognostic association supporting standard management,” the investigators said.

This analysis included observational studies of adult patients admitted for acute UGIB comparing in-hospital all-cause mortality between patients receiving antithrombotic therapy (antiplatelets, anticoagulants, or both) at admission and those not, following Cochrane and PRISMA recommendations.

Seventeen studies published between 2004 and 2025 were included (18,712 patients; 6,558 on antithrombotic therapy at presentation and 12,154 not). In-hospital all-cause mortality, extended to 30-day mortality where in-hospital data were not separately reported, was the primary endpoint.

“Antithrombotic agents have been linked to a higher risk of gastrointestinal bleeding, but their impact on in-hospital mortality remains controversial, with observational studies variably reporting increased, unchanged, or reduced mortality,” the investigators said.