Clinical Profile and Outcomes of Patients with Concurrent Acute Myocardial Infarction and Gastrointestinal Bleeding: Challenges in Antithrombotic Management

Abstract

Background: Concurrent acute myocardial infarction (AMI) and gastrointestinal bleeding (GIB) presents a major therapeutic challenge because antithrombotic therapy reduces ischemic risk but may worsen active bleeding. Careful balancing of these competing risks is essential for improving outcomes.

Objective: To evaluate the clinical profile, antithrombotic management, and in-hospital outcomes of patients presenting with concurrent AMI and GIB.

Methods: This retrospective observational study was conducted at the Department of Internal Medicine Saidu Teaching Hospital Swat from August 2025 to December 2025. Demographic characteristics, comorbidities, type of AMI, hemoglobin level, left ventricular ejection fraction (LVEF), bleeding presentation, endoscopic management, transfusion requirement, antithrombotic therapy, and in-hospital outcomes were recorded.

Results: The mean age was 63.92±11.60 years, and 78 (65.0%) patients were male. STEMI was present in 67 (55.8%) patients. Patients with adverse outcomes had lower hemoglobin (8.50±2.00 vs. 10.30±1.80 g/dL, p<0.001) and lower LVEF (39.80±10.20% vs. 48.70±9.50%, p<0.001). Antithrombotic therapy was interrupted in 61 (50.8%) patients. Interruption was associated with more recurrent myocardial ischemia (26.2% vs. 6.8%, p=0.004) and reinfarction (18.0% vs. 5.1%, p=0.027), whereas rebleeding was more frequent when therapy was continued (25.4% vs. 11.5%, p=0.048). Independent predictors of adverse outcomes included cardiogenic shock (adjusted OR 4.76), chronic kidney disease (OR 3.02), hemoglobin <9 g/dL (OR 2.88), antithrombotic interruption >24 hours (OR 2.79), LVEF <40% (OR 2.67), transfusion requirement (OR 2.42), STEMI (OR 2.31), and age ≥65 years (OR 2.24).

Conclusion: Patients with concurrent AMI and GIB have substantial risks of both ischemic and bleeding complications. Prolonged interruption of antithrombotic therapy was associated with increased recurrent ischemia, while continuation increased rebleeding. Individualized management, early bleeding control, and timely resumption of antithrombotic therapy are essential.