Spontaneous omental bleeding in the setting of dual anti-platelet therapy with ticagrelor.
A 68 year-old man, initially managed with primary percutaneous coronary intervention (PCI) to the right coronary artery (RCA) for an inferior ST elevation myocardial infarction (STEMI) with residual disease requiring coronary artery bypass graft surgery (CABG), re-presented with chest pain. There were no acute ischaemic changes on ECG and his pain settled with nitrates. A day later, he developed left sided abdominal pain and hypovolaemic shock after straining in the toilet. A subsequent computed tomography (CT) scan of his abdomen revealed an omental bleed. He proceeded to emergency laparotomy, recovered well, and was discharged on aspirin and clopidogrel. Apart from dual antiplatelet therapy with aspirin and ticagrelor, and presumed raised intra-abdominal pressure, there were no other identified risk factors for increased bleeding.
Department of Cardiology, Western Hospital, Gordon Street, Footscray, Melbourne, Australia. Electronic address: victoria.cheng@wh.org.au.
Victoria E
VE
Cheng
Department of Cardiology, Western Hospital, Gordon Street, Footscray, Melbourne, Australia.
Anne
A
Oppermen
Department of Cardiology, Western Hospital, Gordon Street, Footscray, Melbourne, Australia.
Dinesh
D
Natarajan
Department of Cardiology, Western Hospital, Gordon Street, Footscray, Melbourne, Australia.
Deepak
D
Haikerwal
Department of Cardiology, Western Hospital, Gordon Street, Footscray, Melbourne, Australia.
Jeremy
J
Pereira
D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D001241:Aspirin; D000077144:Clopidogrel; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
Acute coronary syndrome; Haemoperitoneum; Haemorrhage; Platelet aggregation inhibitors; Ticagrelor