Clinical Characteristics, Management, and Outcomes of Gastrointestinal Bleeding Among Patients Receiving Antiplatelet Therapy, Anticoagulant Therapy, or Neither: A Retrospective Observational Cohort Study

Background: Gastrointestinal bleeding (GIB) is a clinically important cause of emergency assessment and hospitalization. Antiplatelet and anticoagulant therapies are widely used for cardiovascular and thromboembolic prevention but may complicate the management of bleeding. Comparing patients receiving these therapies with patients receiving neither can help describe differences in clinical profiles, management, and outcomes. Objective: To compare the clinical characteristics, management strategies, and outcomes of patients with GIB according to antiplatelet and anticoagulant medication exposure, and to examine factors associated with 28-day all-cause mortality. Methods: A retrospective observational cohort study was conducted at a tertiary care hospital in India from 1 February 2023 through 1 February 2026. The study included 5,000 records: 3,850 patients receiving neither antiplatelet nor anticoagulant therapy, 1,000 receiving antiplatelet therapy, and 150 receiving anticoagulant therapy. Medication exposure and clinical outcomes were abstracted from medical records. Results: The mean age was 57.9 ± 16.6 years, and 32.0% of patients were female. Peptic ulcer disease was the most frequently reported diagnosis (52.7%). Hypertension was more frequent in the antiplatelet group than in the reference group (79.4% vs 32.9%). Rebleeding within 28 days occurred in 486 patients (9.7%), and 28-day all-cause mortality occurred in 192 patients (3.8%). The reported multivariable analysis identified antiplatelet exposure, anticoagulant exposure, age, chronic kidney disease, low hemoglobin, low systolic blood pressure, and elevated lactate as factors associated with 28-day mortality. Conclusion: In this retrospective cohort, clinical characteristics, management, and outcomes differed across the reported medication-exposure groups. The findings describe associations and should not be interpreted as evidence of causation.