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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Small bowel ulcer bleeding due to suspected clopidogrel use in a patient with clopidogrel resistance: A case report
Sang Hoon Lee, Dong Ryeol Ryu, Sung Joon Lee, Sung Chul Park, Byung Ryul Cho, Seung Koo Lee, Sang Ji Choi, Hyun Seok Cho
Sang Hoon Lee, Sung Joon Lee, Sung Chul Park, Division of Gastroenterology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si 24289, South Korea
Dong Ryeol Ryu, Byung Ryul Cho, Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si 24289, South Korea
Seung Koo Lee, Department of Anatomic Pathology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si 24289, South Korea
Sang Ji Choi, Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si 24289, South Korea
Hyun Seok Cho, Department of Hospital Medicine, Kangwon National University Hospital , Chuncheon-si 24289, South Korea
Author contributions: Lee SH and Cho HS was the patient’s doctor; Lee SH performed endoscopy and capsule endoscopy; Choi SJ performed the surgery; Lee SH and Ryu DR reviewed the literature and contributed to manuscript drafting; Park SC, Lee SJ and Cho BR reviewed images and contributed to manuscript drafting; Lee SK performed histological analysis.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Dong Ryeol Ryu, MD, PhD, Professor, Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Baengnyeong-ro 156, Chuncheon-si 24289, South Korea. rdr0203@hanmail.net
Received: December 21, 2020
Peer-review started: December 21, 2020
First decision: February 25, 2021
Revised: March 10, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: May 26, 2021
BACKGROUND
Clopidogrel is a platelet aggregation inhibitor used for the management of cardiovascular disease. While antiplatelet therapy decreases cardiovascular events after successful coronary drug-eluting stenting, it increases the risk of gastrointestinal (GI) bleeding. About 20% of the patients who take clopidogrel exhibit resistance to the drug.
CASE SUMMARY
We report the first case of a small bowel bleeding ulcer in an 86-year-old man with clopidogrel resistance. He had a history of taking clopidogrel due to unstable angina. There was no evidence of bleeding in the stomach, duodenum, or colon through upper and lower GI endoscopies. The abdominal computed tomography showed the extravasation of radiocontrast media at the ileum. Because of unstable vital signs, emergency surgery was performed. Multiple ulcers with inflammation were found in the ileum. The pathologic findings revealed simple inflammation. The VerifyNow P2Y12 test showed clopidogrel resistance. One year after changing to aspirin, capsule endoscopy was performed and the small bowel ulcers were improved.
CONCLUSION
Small bowel ulcers and bleeding due to clopidogrel are not very common, but the prevalence is expected to increase in older age patients with risk factors despite clopidogrel resistance.
Core Tip: Small bowel injury and bleeding are typical side effects of non-steroidal anti-inflammatory drugs and antiplatelet agents like aspirin. However, there are rare previous reports of small bowel injury and bleeding due to clopidogrel and the mechanisms of ulcer formation in patients receiving clopidogrel therapy are unclear. Here, we report the first case of a small bowel bleeding ulcer in an 86-year-old man with clopidogrel resistance.
