INTRODUCTION. Gastrointestinal bleeding is the most important complication
associated with acetylsalicylic acid therapy. Patients with preexisting
haemostatic disorders are at the higher risk and may experience
life-threatening hemorrhagic syndrome. Platelet transfusions and
desmopressin administration commonly successfully arrest bleeding. However,
in clinical situations with profound bleeding and haemorrhagic shock, these
therapeutic approaches may fail. CASE OUTLINE. We report a 24-year old
female patient with previously undetected acquired platelet dysfunction, who
underwent reconstructive surgical intervention. On the 20th postoperative
day, acetylsalicylic acid was introduced due to reactive thrombocytosis
(platelet count 1480x109/L) with daily dose of 100 mg tablets. On the 12th
day of the acetylsalicylic acid treatment, massive gastrointestinal bleeding
with haemorrhagic shock suddenly occurred. Attempts to control massive
haemorrhage by resuscitation, blood products and haemostatics (desmopressin,
tranexamic acid) failed. Two bolus doses of recombinant activated factor VII
(rFVIIa) (100 ?g/kg and 60 ?g/kg respectively) in 90 minutes interval were
given. Bleeding was successfully controlled with no requirements for further
haemoproducts and haemostatic remedies treatment. CONCLUSION. This case
demonstrates that the use of rFVIIa may be a specific treatment option in
patients suffering from severe gastrointestinal bleeding associated with
acetylsalicylic acid treatment.
Postmortem diagnosis of massive gastrointestinal bleeding