Dual Antiplatelet Agent—Induced Spontaneous Liver Hematoma

OBJECTIVE:To report a case of a spontaneous liver hematoma in a patient receiving dual antiplatelet therapy for 5 years after coronary stent implantation.CASE SUMMARY:A 76-year-old man with coronary artery disease presented to the hospital with acute right upper quadrant pain. He had been taking clopidogrel 75 mg/day, a P2Y12 inhibitor, and aspirin 81 mg/day for 5 years after having a drug-eluting stent (DES) placed. Given a drop in hemoglobin (from 13.0 g/dL to 8.6 g/dL) and elevated liver enzymes, subsequent studies were performed and revealed a large liver hematoma. Clopidogrel and aspirin were discontinued. Aspirin was restarted 1 month later; there was no recurrence of bleeding.DISCUSSION:Current guidelines recommend that a P2Y12 inhibitor and aspirin after DES implantation be given for at least 12 months. However, because of concern for late stent thrombosis, some clinicians encourage patients to continue taking dual antiplatelet therapy beyond this period as long as the risk of bleeding is low. An ...