Abstract
Objective: To report a picture of challenging management of a patient with recent acute myocardial infarction that has an absolute indication of discontinuation of antiplatelet therapy due to upper digestive hemorrhage due to bulbar angioectasis. Details of the case: Elderly, hypertensive patient, ex-smoker, using acetylsalicylic acid, clopidogrel, atorvastatin, metoprolol e captopril after primary angioplasty with stent implantation due to acute myocardial infarction with ST-segment elevation, evolved with burning epigastric pain, melena and adamia. Upper gastrointestinal endoscopy showed angioectasis in the duodenal bulb with bleeding in bleeding. At hemogram, hemoglobin of 5.2 g / dL. The patient had a good response to endoscopic angioectasis ablation and was discharged with suspension of antiplatelet therapy. Final considerations: Despite the lack of data in the literature, this study aims to report a difficult to manage situation about the ideal time to reintroduce double antiplatelet therapy, despite the benefit of such drugs in patients who have undergone percutaneous coronary intervention, such as reducing the risk of infarction recurrence, in cases of evident risk of bleeding in which the patient has an absolute indication of discontinuation of antiplatelet therapy, it is necessary to individualize the indication for this pharmacological treatment.