How do you approach the management of older adult patients with coronary artery disease on aspirin who have developed intermittent diverticular bleeds?

This is a tough clinical scenario that comes up often in older adults. You will often have subspecialists involved and will need to adapt your approach to their management and communication styles. Generalists can add value here by looking at the whole picture and figuring out what matters most to the patient.

• How strong is the indication for aspirin? STEMI 9 months ago is a lot different from asymptomatic CAD diagnosed via imaging.
• How bad is the bleeding? Was there severe anemia?
• Does the pat...

I agree with Dr. @Dr. First Last. For patients over age 70 with chronic stable CAD, the absolute benefit of low-dose aspirin for prevention of MACE or stroke is 1-2% per year, which yields a number needed to treat (NNT) of 50-100 patients to prevent 1 event per year. Following Dr. Bayer's comments, if the patient had a STEMI 9 months ago, the absolute benefit would be closer to 2%, whereas for the patient with asymptomatic CAD diagnosed by imaging, the absolute benefit would be closer to 1%. Thu...

Call an experienced GI endoscopist.

Endoscopic Treatment: Once the bleeding diverticulum is identified, doctors can use several methods to stop it:

• Endoscopic Band Ligation (EBL): Suctioning the bleeding diverticulum into a cap and cinching it off with a rubber band has become a highly effective, preferred mechanical technique.
• Endoscopic Clipping: Applying mechanical metal clips to close off the bleeding vessel or diverticular opening.