Two studies showed that low-dose ASA should be continued after upper and after lower GI bleeding:
- Upper GI bleed: Ann Intern Med 2010; 152:1
- Lower GI bleed: Chan FKL et al. Gastroenterology 2016 Aug
- 295 patients hospitalized with non-fatal LGIB
- After hospitalization, 59% continued ASA, 41% stopped.
- In multivariable analysis (adjusting for differences between groups in several baseline characteristics), aspirin continuers had significantly higher probability of recurrent lower GI bleeding (hazard ratio, 2.76) but significantly lower probability of serious adverse CV events (HR, 0.59) and significantly lower overall mortality.
Summary: go ahead and re-start low-dose ASA in high-risk CAD patients after GI bleed.