Control of acute phase intestinal bleeding after percutaneous coronary intervention by discontinuing dual antiplatelet therapy and implementing intra-aortic balloon pumping

Abstract

Aspirin's efficacy for the prevention of secondary vascular disease is well supported. However, more attention should be given to its side effects, especially gastrointestinal injury. A 62-year-old man suffered acute myocardial infarction of the left main trunk. Although a percutaneous coronary intervention, using a bare metal stent, was successful, intractable in-bowel bleeding developed. To control the bleeding, we discontinued dual antiplatelet therapy during the acute phase, and used intra-aortic balloon pumping to provide sufficient coronary flow to prevent stent thrombosis. This strategy controlled intestinal bleeding without any thrombotic complications, indicating that intra-aortic balloon pumping is effective for preventing stent thrombosis.<Learning objective: Aspirin often causes bleeding complications, especially in the gastrointestinal tract. We experienced a case with severe intestinal bleeding of unknown origin during the acute phase after percutaneous coronary intervention for acute myocardial infarction. The dual antiplatelet therapy was necessarily stopped, which could have resulted in stent thrombosis. We used intra-aortic balloon pumping to prevent the stent thrombosis through coronary flow augmentation.>