Dual Risk Prediction Model for Cardiovascular Events and Rebleeding in Patients with Antiplatelet Drug-Related Gastric Ulcer Bleeding

Objective To develop a dual risk prediction model for cardiovascular events and rebleeding in patients with antiplatelet-related gastric ulcer bleeding, addressing the clinical dilemma of balancing thrombotic and hemorrhagic risks. Methods In a retrospective cohort of 213 patients followed for 12 months, we used Cox regression to identify independent predictors for each outcome. Model performance was assessed using AUC, calibration (Hosmer–Lemeshow test), and bootstrap validation. Results During follow-up, 48 (22.5%) patients had cardiovascular events and 56 (26.3%) experienced rebleeding. Independent predictors for cardiovascular events were age ≥ 70 years (HR = 2.48), heart failure (HR = 2.31), GRACE score > 140 (HR = 2.92), and albumin < 35 g/L (HR = 1.85). For rebleeding, Forrest Ia–Ib (HR = 3.15), Rockall score ≥ 6 (HR = 2.68), H. pylori infection (HR = 1.92), and antiplatelet discontinuation (HR = 2.58) were significant. The models showed AUCs of 0.758 and 0.781 for 12-month cardiovascular events and rebleeding, respectively, with good calibration (P > 0.05). Stratification into low-, medium-, and high-risk groups revealed graded outcomes: cardiovascular event rates were 8.2%, 22.6%, and 57.1%, and rebleeding rates were 10.5%, 28.4%, and 50.0% (P < 0.001). Conclusion This dual risk model effectively stratifies patients by cardiovascular and rebleeding risk using routinely available clinical variables, aiding individualized antiplatelet management.