Gastric ulcer with hemorrhage due to concomitant use of aspirin and warfarin

Be careful out there.
http://www.cadrj.com/qikan/epaper/zhaiyao.asp?bsid=17701

Abstract  

A 62-year-old male patient received combined therapy with aspirin 0.1 g once daily and warfarin 3.0 mg once daily for prevention of thrombosis after undergoing aortic valve replacement. On day 5 of treatment, he presented with vague pain in the upper abdomen. On day 14, his abdominal pain worsened and, on day 15, he presented with melena. Laboratory tests showed the following values: red blood cell count 2.2×1012/L, hemoglobin 65 g/L, prothrombin time (PT) 45.9 s, international normalized ratio (INR) 3.7, fecal occult blood (++). Gastroscopy revealed gastric ulcer with hemorrhage. Aspirin and warfarin were withdrawn, and then the patient was given hemostatic and symptomatic treatment. On day 2, the patient’s abdominal pain was relieved and hemorrhage ceased. His PT decreased to 12.8 s and his INR decreased to 1.1 one week later. The patient resumed the anticoagulation treatment with warfarin.