Mallory Weiss Tear - An Uncommon Cause of Upper G.I Bleeding in a Cardiac Patient with Successful Dual Intervention

Introduction: Primary Percutaneous Coronary Intervention (PPCI) with stenting, especially with Drug eluting stents (DES), is the most widely accepted strategy globally for patients presented with STEMI, which necessitates a long duration of Dual antiplatelet therapy (DAPT) to prevent stent thrombosis. Potent P2Y12 inhibitors for DAPT are preferred in view of their superior protection against thrombosis but at the expense of increased bleeding risks. Early therapeutic intervention in the event of acute GI bleed has beneficial outcome while on active cardiac intervention.

Case Presentation: A 67-year-old patient, who underwent PPCI with DES stent, incidentally developed Mallory-Weiss (MW) tear, which manifested as severe hematemesis when loaded with DAPT consisting of Aspirin and Ticagrelor. The therapy was withheld until the clipping of the tear was done. Single antiplatelet therapy (SAPT) with Aspirin was reinstituted after a day and DAPT with Aspirin plus Clopidogrel after a week.

Conclusion: A careful assessment of the risks and benefits of acute coronary interventions need to consider complications and timely interventions thus individualizing and curating the DAPT as deemed necessary.