{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:00:42Z","timestamp":1784826042669,"version":"3.55.0"},"reference-count":16,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Gastroenterol"],"abstract":"<jats:p>Introduction: Antiphospholipid syndrome (APS) is an acquired thrombophilia. Triple-positive APS, defined by lupus anticoagulant, anticardiolipin, and anti-\u03b22-glycoprotein I antibody positivity, usually requires long-term vitamin K antagonist therapy; direct oral anticoagulants are discouraged, and low-molecular-weight heparin is reserved for selected situations. Case Presentation: A 52-year-old female with systemic lupus erythematosus and triple-positive APS on warfarin (International Normalized Ratio [INR] 2.9) presented with massive hematemesis requiring intubation. Serial esophagogastroduodenoscopy showed extensive esophageal clot burden followed by circumferential friability, sloughing, and necrotic\/exudative esophagitis without varices or gastric\/duodenal bleeding. Hemostatic powder was applied, fresh frozen plasma partially corrected the INR to 1.8, and anticoagulation was held. Therapeutic heparin bridging on hospital day 8 was followed by recurrent melena, hemoglobin decline from 8.3 to 5.5 g\/dL, and gross hematuria; INR at rebleeding was 2.2. Hematology evaluation showed factor VIII activity 87% and negative Bethesda assay, arguing against acquired hemophilia A. Repeat endoscopy showed Los Angeles grade C esophagitis with clean-based linear ulcers and a 7-cm sliding hiatal hernia. Conclusion: Severe diffuse esophageal mucosal injury can cause recurrent major bleeding when anticoagulation is resumed before mucosal recovery. In high-risk APS, anticoagulation resumption should be individualized with hematology and gastroenterology input, and repeat endoscopy may help guide timing.<\/jats:p>","DOI":"10.1159\/000552878","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:00:48Z","timestamp":1780675248000},"page":"266-275","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma"],"prefix":"10.1159","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5657-1139","authenticated-orcid":false,"given":"Akram","family":"Alnounou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Zambrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arghyadeep","family":"Ganguly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Boamah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.01753.x"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-04-848333"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215213"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/BF02093805"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.02.043"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-014-3258-4"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/art.42624"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.150268"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-012-2721-x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181b7ce21"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v16.i26.3219"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1159\/000341808"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20390"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.10.044"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.398"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.03.053"}],"container-title":["Case Reports in Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000552878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:01:00Z","timestamp":1784822460000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000552878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000552878","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.32586186","asserted-by":"subject"}]},"ISSN":["1662-0631"],"issn-type":[{"value":"1662-0631","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]}}}