Abstract
We report herein on two cases of ischemic heart disease induced by acute gastrointestinal hemorrhage during antiplatelet therapy. CASE 1: A 64-year-old male was referred to our emergency room (ER) with hematemesis and melena while taking clopidogrel after a cerebral infarction. His epigastric discomfort continued even after endoscopic hemostasis for a bleeding gastric ulcer. Finally, he was diagnosed as having acute myocardial infarction following additional examinations. Cardiac computed tomography and coronary angiography showed severe stenosis of the left anterior descending branch and right coronary artery. Percutaneous coronary intervention was carried out, and thereafter no relapse has been encountered under administration of clopidogrel and a proton pump inhibitor. CASE 2: An 80-year-old male who was given low-dose aspirin for the secondary prevention of cerebral infarction, came to the ER with bloody stools. He was severely anemic and simultaneously complained of angina. Myocardial scintigraphy indicated myocardial ischemia in the antero-septal wall. Angina rapidly disappeared after the improvement in his anemia by blood transfusion. He currently remains well under the good control of only his blood pressure. Antiplatelet therapy is being widely used for atherosclerotic diseases. Thus, gastrointestinal hemorrhage has become the most important adverse event during antiplatelet therapy. Preventive antacid therapy or eradication of Helicobacter pylori before administration is thus recommended. In addition, rapidly advancing anemia is a risk-factor for provoking ischemic heart disease. In conclusion, whenever we see a patient with gastrointestinal hemorrhage under antiplatelet therapy, cardiovascular risk has also to be taken into consideration.
