Case 30-1999

Presentation of CaseAn 86-year-old man was admitted to the hospital because of gastrointestinal bleeding with abdominal pain.The gastrointestinal bleeding had begun a year and a half earlier. The patient was hospitalized at that time because of several episodes of hematochezia and iron-deficiency anemia, with a hematocrit of 26 percent, while he was taking warfarin for the treatment of dilated cardiomyopathy. Laboratory tests were performed (Table 1). Colonoscopic examination and an esophagogastroduodenoscopic study showed no important lesions. The patient was discharged with prescriptions for warfarin and ferrous sulfate, in addition to his other medications.Eleven months before the current . . .