Severe upper gastrointestinal bleeding with gastric ulcer and anaemia secondary to prolonged use of aspirin and clopidogrel – A case report

Abstract

A combination therapy of aspirin with clopidogrel is useful in the prevention of various disorders of cardiovascular system, secondary prophylaxis thrombosis of systemic to pulmonary artery shunts, acute ST-segment elevation myocardial infarction and percutaneous coronary intervention. Traditionally, aspirin has been used for such conditions alone. Clopidogrel is as an alternative choice for aspirin. While the combination therapy shows a better outcome, but also has been associated with risks. Upper gastrointestinal bleeding (UGIB) is one such known adverse effect caused by fibrinolytic therapy, but it normally subsides itself without any treatment and is rarely serious, where the patient requires intensive care and monitoring during hospitalization. And, ulcers are the most common cause of hospitalization for UGIB. Anaemia can be seen in UGIB patients due to ulcers induced by the aspirin plus clopidogrel therapy. Here, we report a serious case of UGIB, gastric ulcer and anaemia in a 66-year-old male patient with structural valve deterioration and stent and upon long term use of combination therapy of aspirin and clopidogrel.