People who have survived a heart attack have gained increasingly better protection against new serious cardiovascular events over the past two decades. At the same time, the risk of bleeding complications has increased. A new study by researchers at Karolinska Institutet shows that bleeding in the gastrointestinal tract is the most common type of serious bleeding after a heart attack.
Treatment after myocardial infarction has changed considerably since the late 1990s. Today, more patients undergo percutaneous coronary intervention (PCI) and receive antithrombotic therapy. While these treatments reduce the risk of recurrent myocardial infarction and other major adverse cardiovascular events, they may also increase the risk of bleeding.
In the new study, published in European Journal of Preventive Cardiology, researchers analysed data from the SWEDEHEART registry. The study included patients with acute myocardial infarction who were discharged alive on antithrombotic treatment between 1999 and 2020. The researchers followed the patients for one year after discharge to examine how adverse outcomes changed over time.
The results show that the proportion of patients requiring hospitalisation for bleeding increased from 2.4 per cent at the beginning of the study period to 4.5 per cent at the end. At the same time, the incidence of major adverse cardiovascular events, including recurrent myocardial infarction, stroke and death, decreased from 20.1 per cent to 9.4 per cent.
Photo: Private
The most common source of bleeding was the gastrointestinal tract, and most of these bleeds came from the upper gastrointestinal tract, such as the oesophagus, stomach or duodenum.
“We found that bleeding from the upper gastrointestinal tract was the most common type of bleeding leading to hospital care after a heart attack. At the same time, ischaemic complications decreased, showing how the treatment landscape has changed over time,” says Jonatan Wärme , doctoral student at the Department of Clinical Research and Education, Södersjukhuset (KI SÖS).
The researchers also studied possible explanations for this development. During the study period, the use of coronary interventions, dual antiplatelet therapy, more potent antithrombotic medicines and direct oral anticoagulants increased. The analyses suggest that changes in treatment strategies may have contributed to the increased incidence of bleeding from the upper gastrointestinal tract.
Photo: Fotogruppen SÖS
“Our findings highlight the importance of tailoring antithrombotic therapy to the individual patient’s risk profile and considering measures to protect the gastrointestinal tract,” says Robin Hofmann , Senior Consultant at the Cardiology Clinic, Södersjukhuset, and Principal Investigator and Docent at KI SÖS.
According to the researchers, the results may help improve the balance between preventing thrombotic events and reducing the risk of bleeding complications in patients treated for myocardial infarction.
Publication
“Long-term Trends in Upper Gastrointestinal Bleeding and Ischemic Outcomes after Myocardial Infarction”, Jonatan Wärme et al, European Journal of Preventive Cardiology, 2026
