To explore the effect of different restart timing of antiplatelet drugs on the risk of rebleeding and cardiovascular events in patients with peptic ulcer bleeding complicated by coronary heart disease.

From January 2020 to December 2023, patients with peptic ulcer bleeding complicated with coronary heart disease who were admitted to Aerospace Center Hospital were selected. Among them, 150 patients whose antiplatelet drug restart time was ≤7 days were classified as the early restart group, and 150 patients whose antiplatelet drug restart time was >7 days were classified as the delayed restart group. A retrospective cohort analysis was conducted. The occurrence of rebleeding and major adverse cardiovascular events (MACE) within half a year between the two groups of patients, including myocardial infarction, stroke, and cardiovascular death were compared. The patients were further divided into the occurrence group (n=81, 36 cases of rebleeding and 45 cases of MACE) and the non-occurrence group (n=219) based on whether rebleeding and MACE occurred within half a year. Clinical data of patients were collected. COX regression was used to analyze the risk factors, and the ROC curve was used to evaluate each risk factor and the combined predictive efficacy.

The incidence of rebleeding within six months in the early restart group (8.00%) was lower than that in the delayed restart group (16.00%) (P<0.05), and the total incidence of MACE within six months in the early restart group (12.00%) was slightly lower than that in the delayed restart group (18.00%), but there was no statistical difference (P>0.05). The diameter of ulcers, the proportion of high-risk Forrest grading, the ratio of neutrophil to lymphocyte count (NLR), C-reactive protein (CRP), troponin I, N-terminal B-type natriuretic peptide precursor (NT-proBNP), the proportion of non-pharmacological hemostasis methods, and the proportion of antiplatelet drug restart time>7 days in the occurrence group were all higher than those in the non-occurrence group (all P<0.05). The left ventricular ejection fraction (LVEF) in the occurrence group was lower than that in the non-occurrence group (P<0.05). The results of COX regression analysis showed that ulcer diameter, Forrest classification, LVEF, NLR, and the timing of restarting antiplatelet drugs were all influencing factors for rebleeding and cardiovascular events (all P<0.05). The ROC results indicated that ulcer diameter, Forrest classification, LVEF, NLR, the timing of restarting antiplatelet drugs, and the combined predictive model could all predict the risk of rebleeding and cardiovascular events. The area under the curve of the combined prediction model was 0.953 (95% CI: 0.928-0.978). When the cut-off value was taken, its sensitivity and specificity were 0.945 and 0.827, respectively.

In terms of the time to restart antiplatelet drugs, the early restart group has a lower incidence of rebleeding and MACE. Ulcer diameter, Forrest classification, LVEF, NLR, and the timing of antiplatelet drug restart are all risk factors for rebleeding and cardiovascular events.