rebleeding

Rebleeding is the recurrence of bleeding after initial control has been achieved for a prior bleeding event. It can occur in diverse settings, most commonly in medicine and surgery, including gastrointestinal bleeding from ulcers or variceal disease, intracranial hemorrhage, post-operative sites, or traumatic/iatrogenic bleeds. In clinical practice, rebleeding is typically defined as renewed bleeding after stabilization and may be described as early or late based on the time elapsed since initial treatment.

Common causes and risk factors include the persistence or recurrence of the underlying lesion, incomplete hemostasis, coagulopathy, ongoing use of anticoagulants or antiplatelet agents, hypertension, infection, or inadequate supportive care. In peptic ulcer or variceal bleeds, rebleeding often reflects re-bleeding from the original source or a second lesion developing after initial therapy.

Presentation and diagnosis involve signs of renewed blood loss such as hematemesis, melena, hematochezia, a drop in hemoglobin, or new hemodynamic instability. Evaluation may require repeat physical examination, laboratory testing, and targeted imaging or endoscopy to identify the source and guide therapy.

Management emphasizes rapid resuscitation and stabilization, including airway protection if needed, intravenous fluids, blood products, and correction of coagulopathy. Specific treatment depends on the source: repeat endoscopy or angiography with hemostatic therapy for GI bleeds, pharmacologic treatments (for example, proton pump inhibitors or vasoconstrictors in variceal bleeds), antibiotics in cirrhotics, and surgical or endovascular interventions for refractory cases. Prevention focuses on treating the underlying cause, risk stratification, minimizing contributing medications, and ensuring definitive therapy is completed promptly.

Prognosis worsens with rebleeding, increasing mortality risk, hospital stay, and the need for invasive interventions.