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Upper gastrointestinal bleeding and erosive gastritis: case report A 75-year-old woman developed upper gastrointestinal (UGI) bleeding and erosive gastritis during anticoagulant therapy with aspirin and clopidogrel. The woman, who had diabetes and hypertension, presented with typical angina following ordinary activity for 1 month. Coronary angiography revealed anomalous left anterior descending coronary artery (LCA) originating from the right coronary artery (RCA) close to the ostium and 90% stenosis of mid RCA. Therefore, she underwent a percutaneous coronary intervention (PCI) resulting in TIMI 3 flow. She started receiving aspirin 81 mg/day and clopidogrel 75 mg/day. Her concomitant medications included metoprolol, atorvastatin and esomeprazole. Two weeks later, she presented with intense fatigue, tarry stool, dyspnoea and pallor. Her haemoglobin level was found to be dropped at 8g% [time to reaction onset not stated]. The woman therefore received transfusion of two units of whole blood. After stabilisation, a UGI endoscopy showed erosive gastritis. She was then treated with unspecified IV proton pump inhibitors. However, she presented with 3 episodes of UGI bleeding over the subsequent 4 months and was treated in similar fashion. Following the fourth episode of UGI bleeding, her aspirin therapy was permanently discontinued; while the remaining medications were continued. Thereafter, she attained a clinical stability without fatigue or chest pain for 5 months. Nine months following the initial presentation, she developed a new discrete 90% of stenosis of the proximal RCA, underwent a PCI and started receiving ticagrelor as the only antiplatelet agent. At recent follow-up visit 2 months later, she experienced no bleeding episode. Author comment: "After two weeks [of antiplatelet therapy]. . .upper gastrointestinal (UGI) endoscopy. . .revealed erosive gastritis". "[T]he patient had to present for 3 other episodes of UGI bleeding over 4 months". Shashu BA. Utilization of ticagrelor as a sole anti-platelet agent in a patient with high risk of bleeding and an anomalous origin of left anterior descending coronary artery from right coronary artery. Cardiovascular Journal of South Africa 30 (Suppl. 1): 23 abstr. P088, Sep 2019. Available from: URL: http://www.cvja.co.za/ downloads/PanAfrican-Course-on-Interventional-Cardiology-PAFCIC-2019.pdf 803437949 [abstract] - Ethiopia

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Reactions 7 Dec 2019 No. 1782