Upper GI Bleed (Antiplatelet) — ESEGH MCQ

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HardGastroenterologyUpper GI Bleed (Antiplatelet)ESEGH

A 59‑year‑old man on low‑dose aspirin for secondary prevention of cardiovascular events presents with melena from an upper gastrointestinal bleed. After successful endoscopic hemostasis has been achieved, when should aspirin be resumed?

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Correct answer: C — Resume within 24 hours if hemostasis achieved

NICE guideline CG141 recommends continuation of low‑dose aspirin for secondary prevention once hemostasis is achieved in upper GI bleeding, emphasising net benefit outweighs bleeding risk. ESGE guidelines further refine this by advising immediate resumption of aspirin (within 24 hours) for low‑risk lesions (e.g. Forrest FIIc, FIII) after endoscopic hemostasis. Option C aligns with both UK NICE guidance and EU-endorsed ESGE recommendations. The other options are incorrect: A would remove critical secondary prevention benefit; B or D impose unnecessary delay and increase thrombotic risk; E improperly conditions timing on H. pylori status, which is important for ulcer management but not timing of aspirin resumption.

Reference: NICE CG141 (2012, updated 2016) acute upper GI bleeding: continue low‑dose aspirin; ESGE Guideline 2015 on non‑variceal upper GI hemorrhage: resume aspirin immediately for low‑risk lesions (FIIc, FIII), https://www.nice.org.uk/guidance/cg141/chapter/Recommendations