Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The…

Case reportCase reports in gastroenterology· Jan 2026

Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma.

Akram Alnounou, Chelsea Zambrano, Arghyadeep Ganguly, Harry Boamah

GastroenterologyCase reportClinical practiceQ4IF 0.7

Resuming anticoagulation before esophageal healing was followed by recurrent bleeding in triple-positive antiphospholipid syndrome.

Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma.

Akram Alnounou … Harry Boamah

Case reports in gastroenterology · Jan 2026

Background

Antiphospholipid syndrome (antiphospholipid syndrome) is an acquired thrombophilia.

8.3

Results

8.3

to 5.5 g/dL

hemoglobin fell sharply, a sign of major bleeding

More results

CASE PRESENTATION: A 52-year-old female with systemic lupus erythematosus and triple-positive antiphospholipid syndrome on warfarin (International Normalized Ratio [INR] 2.9) presented with massive hematemesis requiring intubation.

More results

Hemostatic powder was applied, fresh frozen plasma partially corrected the INR to 1.8, and anticoagulation was held.

Hematology evaluation showed factor VIII activity 87% and negative Bethesda assay, arguing against acquired hemophilia A.

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Conclusion · 1 of 2

Severe diffuse esophageal mucosal injury can cause recurrent major bleeding when anticoagulation is resumed before mucosal recovery.

Conclusion · 2 of 2

In high-risk antiphospholipid syndrome, anticoagulation resumption should be individualized with hematology and gastroenterology input, and repeat endoscopy may help guide timing.

Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma.

Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma.

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