title: Acute Atherothrombotic Disease and Severe Bleeding: A Difficult Clinical Presentation in Medical Practice.
abstract: Management of antithrombotic therapy in elderly patients with unstable atherothrombotic disease and increased risk of bleeding is a major clinical challenge. We report the case of a 79 year- old diabetic man with rheumatoid arthritis on both oral corticosteroids and NSAID therapy with mild renal dysfunction, who presented to our hospital because of disabling claudication. Prior to admission he had several episodes of TIA. He also had recurrent small rectal bleeding and mild anemia attributed to his long-standing hemorrhoid disease. Angiography showed a sub-occlusive left internal carotid artery stenosis associated with a significant LAD stenosis and complex peripheral artery disease. Cataclysmic bleeding and hemorrhagic shock occurred in the third day post admission. Withdrawal of all antithrombotic treatment, blood transfusion and emergency sigmoidectomy were performed for bleeding colonic diverticulosis. Subsequently antiplatelet therapy was reinitiated and the patient successfully underwent left carotid artery endarterectomy and LAD stenting. He was discharged from hospital on the 21(st) day post admission and is doing well at 24 months follow-up.
authors.forename: Cristina
authors.initials: C
authors.lastname: Căldăraru
authors.forename: C
authors.initials: C
authors.lastname: Popa
authors.forename: Ana
authors.initials: A
authors.lastname: Fruntelată
authors.forename: Ş
authors.initials: Ş
authors.lastname: Bălănescu
mesh_terms: D000368:Aged; D000792:Angiography; D000077144:Clopidogrel; D003082:Colectomy; D003125:Colostomy; D004238:Diverticulitis / Q000150:complications; D016894:Endarterectomy, Carotid; D017984:Enoxaparin / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000601:surgery; D006401:Hematologic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014652:Vascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D017984:Enoxaparin; D006401:Hematologic Agents; D000077144:Clopidogrel; D013988:Ticlopidine