Life-threatening upper gastrointestinal bleeding associated with aspirin and Salvia miltiorrhiza combination therapy presenting as seizures: a case report

Gastrointestinal bleeding is a prevalent medical emergency, often presenting with symptoms such as hematemesis, melena, and dizziness. While the link between antiplatelet therapy and gastrointestinal bleeding complications is well established, atypical initial manifestations—such as seizure-like episodes in stroke patients—are exceedingly rare. This report details a case of massive gastrointestinal bleeding associated with aspirin– Salvia miltiorrhiza (Danshen) combination therapy, which initially presented with jet-like vomiting, seizures, and loss of consciousness. A 68-year-old male with a history of hypertension and cerebral infarction was admitted for abdominal distension. Initial imaging did not reveal any new ischemic lesions. During hospitalization, he experienced sudden jet-like vomiting, seizures, and loss of consciousness. Despite stable blood pressure and a negative occult blood test for vomitus, laboratory results indicated a significant drop in hemoglobin levels. Emergency endoscopy revealed a large ulcer with an adherent blood clot in the duodenal bulb, leading to a diagnosis of upper gastrointestinal bleeding. Due to the risks associated with active massive hemorrhage and potential perforation from electrical injury during endoscopic clot removal—which could complicate wound management—conservative medical management was implemented. The patient recovered without recurrent bleeding, demonstrated improved hemoglobin levels, and was successfully discharged. This case illustrates that gastrointestinal bleeding can present atypically with neurological symptoms such as seizures and altered consciousness, which may contribute to misdiagnosis. A heightened level of suspicion is essential in patients on antithrombotic therapy, even in the absence of conventional bleeding indicators. Furthermore, this case emphasizes the importance of drug safety awareness regarding aspirin combination therapy and the necessity for clinicians to regularly assess patients and implement measures to mitigate the risk of drug-induced gastrointestinal bleeding.