Acute GI Hemorrhage in a Woman on Aspirin and Clopidogrel
Acute GI Hemorrhage in a Woman on Aspirin and Clopidogrel
A 72-year-old woman presents to the emergency room after 2 episodes of coffee-ground emesis and a 1-day history of melena. She has no other gastrointestinal (GI) symptoms. She complains of dizziness when standing, but denies shortness of breath and chest pain. She has a history of hypertension, diabetes, and coronary artery disease. Three weeks ago, she sustained a myocardial infarction and had 3 drug-eluting coronary artery stents placed. She takes insulin, metformin, metoprolol, aspirin, and clopidogrel. Her vital signs at presentation show orthostasis with a heart rate of 98 supine and 120 upright. Her blood pressure is 135/80 supine and 100/55 upright. The physical examination is unremarkable except for melenic stool on rectal examination. Relevant laboratory values include a hemoglobin level of 8.1, platelet count of 215, blood urea nitrogen level of 38, creatinine level of 1.2, and a normal international normalized ratio.
Clinical Scenario
A 72-year-old woman presents to the emergency room after 2 episodes of coffee-ground emesis and a 1-day history of melena. She has no other gastrointestinal (GI) symptoms. She complains of dizziness when standing, but denies shortness of breath and chest pain. She has a history of hypertension, diabetes, and coronary artery disease. Three weeks ago, she sustained a myocardial infarction and had 3 drug-eluting coronary artery stents placed. She takes insulin, metformin, metoprolol, aspirin, and clopidogrel. Her vital signs at presentation show orthostasis with a heart rate of 98 supine and 120 upright. Her blood pressure is 135/80 supine and 100/55 upright. The physical examination is unremarkable except for melenic stool on rectal examination. Relevant laboratory values include a hemoglobin level of 8.1, platelet count of 215, blood urea nitrogen level of 38, creatinine level of 1.2, and a normal international normalized ratio.
Source...