Drug-Induced Upper Gastrointestinal Bleeding in an Elderly Patient on Long-Term Dual Antiplatelet Therapy: A Case Report

Background: Dual antiplatelet therapy with aspirin and clopidogrel is widely prescribed for secondary prevention in patients with coronary artery disease. However, prolonged use increases the risk of gastrointestinal bleeding, particularly in elderly patients. Case Presentation: We report the case of a 65- year-old male with a history of coronary artery disease and hypertension, on long-term aspirin and clopidogrel therapy, who presented with acute hematemesis and melena. Laboratory evaluation revealed anemia, and endoscopy demonstrated gastric mucosal erosions with active bleeding. Both antiplatelet agents were withheld, and the patient was managed with intravenous proton pump inhibitors, antiemetics, intravenous fluids, and blood transfusion. His condition stabilized, and clopidogrel monotherapy with gastroprotection was reintroduced prior to discharge. Conclusion: This case highlights the risk of serious upper gastrointestinal bleeding in patients receiving long-term dual antiplatelet therapy. Careful risk– benefit assessment, early recognition of adverse effects, and preventive strategies such as concomitant gastroprotection are essential for optimizing patient safety