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QJM Advance Access first published online on February 5, 2008
This version published online on February 11, 2008
QJM, doi:10.1093/qjmed/hcm148
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Management of upper gastrointestinal haemorrhage complicating dual anti-platelet therapy

Peter A. Henriksen1, Kelvin Palmer2 and Nick A. Boon3

From the 1Department of Cardiology,2Department of Gastroenterology, Western General Hospital, Edinburgh, EH42XU, UK and 3Department of Cardiology, The Royal Infirmary of Edinburgh, EH16 4SA, UK.

Address correspondence to Dr P.A. Henriksen, Consultant Cardiologist, Department of Cardiology, Western General Hospital, Edinburgh, EH42XY, UK. email: p.henriksen{at}blueyonder.co.uk

Received 25 March 2007 and in revised form 1 July 2007


  Abstract

Upper gastrointestinal haemorrhage is a serious complication of aspirin and clopidogrel (dual) anti-platelet therapy with a high morbidity and mortality. Using an illustrative case this article examines the prognostic significance of gastrointestinal haemorrhage and the risk of stopping anti-platelet therapy. The management of this clinical challenge is reviewed, in the absence of a clinical guideline, with particular reference to the judicious tailoring of anti-platelet therapy, the role of therapeutic endoscopy and the utility of blood transfusion.


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