Spontaneous omental bleeding in the setting of dual anti-platelet therapy with ticagrelor

Area of Science:

• Cardiology
• Gastroenterology
• Vascular Surgery

Background:

• A 68-year-old man with a history of ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery presented with recurrent chest pain.
• Initial evaluation showed no acute ischemic changes on ECG, and symptoms resolved with nitrates.

Observation:

• The patient later developed severe left-sided abdominal pain and hypovolemic shock after straining.
• Abdominal computed tomography (CT) revealed an omental bleed, necessitating an emergency laparotomy.

Findings:

• The omental bleed was presumed to be associated with dual antiplatelet therapy (aspirin and ticagrelor) and potentially elevated intra-abdominal pressure from straining.
• No other significant risk factors for bleeding were identified.

Implications:

• This case underscores the potential for spontaneous omental bleeds as a rare complication in patients on dual antiplatelet therapy, particularly when combined with increased intra-abdominal pressure.
• Further investigation into the interplay between antiplatelet agents, intra-abdominal pressure, and gastrointestinal bleeding may be warranted.