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However, few studies have addressed the subsequent dilemma of if and when antithrombotic agents should be reintroduced. Consequently, practice is variable and not necessarily evidenced\u2010based. Overall, for patients that are either anticoagulated or using antiplatelet drugs for secondary prophylaxis, there is a clear benefit to restarting these agents. However, there is limited data to guide when this should occur. For individuals at low risk of re\u2010bleeding, current guidelines suggest single agent aspirin can be continued without interruption, assuming haemostatic control has been confirmed endoscopically. For those at higher bleeding risk, aspirin should be withheld, but reintroduced early (within 3\u00a0days of index endoscopy). However, randomised evidence is lacking, as are studies including more modern agents or combined anticoagulant\/ antiplatelet regimens. As such, guidance statements are limited and management suggestions must be extrapolated from clinical trials, retrospective studies and data relating specifically to warfarin and aspirin. The intention of this review is to summarise what evidence is available and, where this is lacking, suggest pragmatic management options based on a risk\u2010benefit assessment of thromboembolism and recurrent bleeding.<\/jats:p>","DOI":"10.1111\/bjh.14599","type":"journal-article","created":{"date-parts":[[2017,3,8]],"date-time":"2017-03-08T06:46:42Z","timestamp":1488955602000},"page":"185-197","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Reintroduction of anti\u2010thrombotic therapy after a gastrointestinal haemorrhage: if and when?"],"prefix":"10.1111","volume":"177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0854-1309","authenticated-orcid":false,"given":"Martin J.","family":"Scott","sequence":"first","affiliation":[{"name":"Department of Haematology Central Manchester University Hospitals NHS Foundation Trust Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Veitch","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology New Cross Hospital Wolverhampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jecko","family":"Thachil","sequence":"additional","affiliation":[{"name":"Department of Haematology Central Manchester University Hospitals NHS Foundation Trust Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,3,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318202f701"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1857"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.09.035"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e3181faec3c"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl334"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2005.01477.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH15-01-0063"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042087"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1585"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.08.034"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH13-02-0150"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2298"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1393172"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu046"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr236"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2295"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02759.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14344"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.11.007"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2011.02827.x"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409312"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.10.039"},{"key":"e_1_2_10_27_1","unstructured":"National Institute for Health and Care Exellence (NICE). 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