Title : Beyond peptic ulcer: A rare complication of dual antiplatelet therapy
Abstract:
Dual Antiplatelet Therapy (DAPT) is widely used for secondary prevention following acute coronary syndrome and percutaneous coronary intervention. Gastrointestinal bleeding is a known complication of DAPT, typically due to peptic ulcer disease or gastritis. However, oesophageal haematoma is a rare and under-recognised cause of Upper Gastrointestinal Bleeding (UGIB) in this setting. We are presenting a case of 65-year-old woman who attended accident and emergency department with chest pain, vomiting, and haematemesis, six months after undergoing PCI and commencing DAPT. Initial investigations raised suspicion for acute coronary syndrome as she presented with chest pain, but coexistent persistent gastrointestinal symptoms prompted further evaluation. Esophagogastroduodenoscopy revealed a large oesophageal haematoma extending to the gastroesophageal junction. Contrast-enhanced CT confirmed a non-perforated lesion without mediastinal air. Clopidogrel was discontinued, and the patient was managed conservatively with intravenous proton pump inhibitors. Follow-up endoscopy demonstrated complete resolution of the haematoma. This case illustrates an uncommon but important complication of antiplatelet therapy and reinforces the need for diagnostic vigilance in patients presenting with atypical gastrointestinal symptoms while on DAPT. Individualised management and multidisciplinary input are key to achieving optimal outcomes.
Categories: Cardiology, Gastroenterology.
Keywords: Clopidogrel, Percutaneous Coronary Intervention, Chest Pain, Gastrointestinal Bleeding, Dual Antiplatelet Therapy, Oesophageal Haematoma.
