American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with upper gastrointestinal bleeding due to peptic ulcer disease, when should aspirin be resumed in those with cardiovascular disease?

1. Within 1 to 2 days

2. Within 3 to 5 days

3. Within 7 to 10 days

4. After 14 days

The correct answer is: Within 3 to 5 days

Resuming aspirin after an upper gastrointestinal bleed due to peptic ulcer disease, particularly in patients with cardiovascular disease, is a critical consideration balancing the risk of rebleeding with the need for cardiovascular protection. The recommendation to resume aspirin within 3 to 5 days following an upper gastrointestinal bleed is supported by clinical guidelines and studies that indicate this timing allows for adequate healing of the ulcer while still providing necessary cardiovascular protection. Research shows that gastrointestinal bleeding can occur in patients taking aspirin, but the risk of serious cardiovascular events rises significantly if antiplatelet therapy is delayed for too long. Waiting until 7 to 10 days or longer can increase the risk for thrombotic events, particularly in patients with a history of cardiovascular disease who rely on consistent antiplatelet therapy to prevent events such as heart attacks or strokes. Resuming aspirin too soon (within 1 to 2 days) may increase the risk of rebleeding, especially if the ulcer has not adequately healed. Therefore, the optimal approach is to resume aspirin within a window of 3 to 5 days post-bleed, balancing the patient's gastrointestinal recovery with their cardiovascular needs. This regimen reflects an understanding of the pathophysiology of both conditions and demonstrates a thoughtful approach to managing