title: [High-dose thalidomide for severe idiopathic obscure gastrointestinal bleeding in a patient at high-thrombotic risk].
abstract: We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300 mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up.
authors: Servicio de Aparato Digestivo, Hospital San Pedro de Alcántara, Cáceres, España.
authors: Elisa
authors: E
authors: Martín-Noguerol
authors: Carmen
authors: C
authors: Martinez-Alcalá
authors: Jesús M
authors: JM
authors: Gonzalez-Santiago
authors: Daniel
authors: D
authors: Vara-Brenes
authors: Javier
authors: J
authors: Molina-Infante
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index; D013792:Thalidomide / Q000008:administration & dosage*; D013927:Thrombosis
chemical_list: D020533:Angiogenesis Inhibitors; D013792:Thalidomide