Successful treatment of bleeding large duodenal gastrointestinal stromal tumour in a patient under dual antiplatelet therapy after recent drug-eluting coronary stent implantation.
We report a case of a 69-year-old man who started dual antiplatelet therapy (APT) with aspirin and clopidogrel after recent implantation of drug-eluting coronary stent and developed massive bleeding due to large duodenal gastrointestinal stromal tumour (GIST). Following endoscopic haemostasis and discontinuation of dual APT, neoadjuvant chemotherapy with imatinib was started under continuation of 'single' APT with aspirin. A good chemotherapeutic response was achieved without recurrence of bleeding, and subsequent less invasive surgical resection of the tumour was performed, while preoperative single APT was continued for prevention of stent thrombosis. The patient recovered well without any thromboembolic or bleeding events. Neoadjuvant imatinib therapy and subsequent less invasive surgery under continuation of APT is one of the preferred approaches for patients with duodenal GIST with severe thromboembolic comorbidities, as in the current case.
Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
Keita
K
Fukuyama
Takahisa
T
Fujikawa
Shoichi
S
Kuramitsu
Akira
A
Tanaka
D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D001549:Benzamides / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D000077144:Clopidogrel; D023921:Coronary Stenosis / Q000628:therapy; D054855:Drug-Eluting Stents; D004379:Duodenal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D046152:Gastrointestinal Stromal Tumors / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D020360:Neoadjuvant Therapy; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011743:Pyrimidines / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D001549:Benzamides; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin