A 70-year-old man who presented epigastralgia and hematemesis just after dinner was admitted to our hospital. He had been taking warfarin for atrial fibrillation, and two months before he had started to take clopidogrel and aspirin for prevention of coronary stent thrombosis. Computed tomography of the chest showed thickening of the upper and lower parts of the esophagus. Because he presented no hematemesis in fair general condition, he was treated with conservative therapy without any anticoagulants. However, esophagogastroduodenoscopy (EGD) revealed near-circumferential intramural esophageal hematoma without active bleeding on the next day. Four days later, the follow-up EGD indicated that the hematoma shrunk slightly, therefore heparin therapy was started. Without any adverse events, soon he resumed oral intake. After the 3rd EGD, heparin was switched to edoxaban and clopidogrel was added thereafter. He was discharged on the 23rd hospital day.
