CLINICAL CROSSROADS CLINICIAN’S CORNER CONFERENCES WITH PATIENTS AND DOCTORS Antiplatelet and Anticoagulant Therapy in Patients With Gastrointestinal Bleeding An 86-Year-Old Woman With Peptic Ulcer Disease Majid A. Almadi, MBBS, FRCPC, MSc(Epi) Bleeding in the upper gastrointestinal tract is a common Alan Barkun, MDCM, FRCPC, MSc(Epi) medical problem, with an incidence of 48 to 160 cases per James Brophy, MEng, MD, FRCPC, PhD 1000 adults per year and a mortality rate of 5% to 14%. The risk of gastrointestinal bleeding is increased with the N 86-YEAR-OLD WOMAN,MS S, IS PHYSICALLY AC- tive, engages in numerous social activities, and at- use of antiplatelet medications including aspirin and clopi- tends a class in political science. She presented to dogrel, as well as warfarin or a combination of these medi- Athe emergency department after falling in her bath- cations. The recurrence rate for bleeding in patients who room. Ms S had been feeling epigastric discomfort that was continue to take aspirin after an episode of peptic ulcer dis- difficult to describe; it was episodic in nature and mild in ease–related bleeding can reach up to 300 cases per 1000 intensity and there were no provocative or palliative fac- person-years and varies by age,
JAMA – American Medical Association
Published: Dec 7, 2011
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