CliniCal CaseThe patient was a sixty-five-year-old male with continuous abdominal pain on the left side which had been developing for 12 hours. Towards the end of that period, the patient showed melanemesis, rectal bleeding, hematuria, whimpering, and rectal and bladder tenesmus. An important event in this patient’s background was ischemic heart disease with myocardial revascularization. A coronary stent had been placed six months before. His condition was being dealt with through dual antiplatelet therapy. He had also presented a deep vein thrombosis with pulmonary embolism three months before. Since then, he had been anticoagulated with low molecular weight heparin and warfarin with irregular monitoring. He was also taking metoprolol, enalapril, and lovastatin. He presented chronic alcohol consumption. At the time he was admitted to the hospital, his blood pressure was 130/80 mm Hg and his heart rate was 54 beats per minute. He was sleepy but did not have any other neurological symptoms. There were no cirrhotic or portal hypertension stigmas. His jugular venous distension was level II and his heart beat and respiratory sounds were normal. The abdomen was soft, without pain, and his intestinal sounds were normal. His symmetrical peripheral pulses were also normal.The patient was hospitalized with a diagnosis of over coagulation, upper and lower gastrointestinal bleeding, and possible urolithiasis.The initial tests showed the following results: prothrombin time 68.4 with 5.8 INR; hemoglobin 16.7 gr., hematocrit 48.9%, platelets: 250,000. The urinalysis showed pro-teinuria of 100 mg, and 6-10 red cells per field. The kidney and urinary track ultrasound was normal.Once hemodynamic stability was achieved, a gastroenterological assessment was requested in order to begin the study and management of gastrointestinal bleeding in an over coagulated patient. Some clinical questions that arose need to be answered by going back to the literature.introduCtionGastrointestinal bleeding is a frequent medical problem. Despite the progress made in its diagnosis and management, it continues to result in significant levels of morbidity and mortality. The more frequent use of anticoagulant therapy has been described as a risk factor that can affect the management and prognosis of gastrointestinal bleeding (1, 2).