Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures. On day 8, she developed deep venous thrombosis, and edoxaban was administered orally. On day 38, she developed fungemia, which was treated with an antifungal drug. On day 43, she presented with dyspnea. Chest computed tomography scan showed bilateral diffuse ground-glass opacities in the whole lung fields. The results of the subsequent workup (i.e., serum levels of the antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane antibody) and microbiological study were unremarkable. Based on these findings, her condition was diagnosed as diffuse alveolar hemorrhage (DAH) associated with edoxaban therapy. The lung opacities disappeared spontaneously after edoxaban therapy was discontinued. Conclusion. DAH is a dangerous complication associated with edoxaban therapy. DOACs, including edoxaban, should be prescribed with caution, especially for patients in a critical condition.

Case: A 72-year-old man with hypertension was admitted with acute-onset chest and back pain followed by epigastralgia. He was transported by helicopter due to suspected acute aortic dissection. Systolic blood pressures were equal in both arms. Physical examination showed epigastric tenderness without rebound. Blood tests showed leukocytosis. Electrocardiogram and echocardiogram were normal. Abdominal radiography showed acute gastric dilatation with an air-outlined large mass-like shadow. Abdominal computed tomography revealed a 6-cm exophytic mass and large intramural hematoma in the lesser curvature of the gastric body.Outcome: The patient underwent urgent laparotomy with total gastrectomy. The resected tumor showed positivity for CD117 and CD34 but negativity for S100, indicating a gastrointestinal stromal tumor. Fourteen days after the surgery, the patient was uneventfully discharged.Conclusion: Intramural bleeding of submucosal tumors including gastrointestinal stromal tumor should be considered in cases of acute gastric dilatation. Abdominal radiography may be a clue regarding the presence of this condition.

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ST elevation by definition) and progressive symptoms, patients who 'rule-in' for an MI with a second or later sample cardiac enzyme elevation, create a poorly described subset of NSTEMI patients. Methods: All patients presenting to the ED and receiving EKG and Cardiac enzyme for chest pain were included in a consecutive, observational study over a 12 month period NSTEMI meant no ST elevation, WHO criteria for chest pain and elevation of CK-MB > 3.0 or Tn I > 0.15 or elevation of both markers. The two groups were divided into those with a cardiac enzyme elevation on initial enzyme or on a later enzyme drawn between 4-6 hr later and repeated 8-12 hr after the first enzyme was drawn. Confirmatory Chart Review for All ED patients diagnosed with Nstemi by Cardiology Admitting Team, patients Followed for 3 mo Post Diagnosis for MACE. Results: 6 Month Study of consecutive patients presenting to ED: 2,894 Chest Pain Patients were admitted, with 4.8% of patients having an AMI (141 Diagnosed AMI). Of that 105 met NSTEMI Criteria with 60 Pts (Early) Initial Cardiac marker elevation (Troponin I) Mean 2.2 hr to diagnosis, and 45 Pts (DD) Delayed Cardiac marker elevation Diagnosed within 5-13 hr. Early N-NSTEMI Delayed N-STEMI Mean Age 64.3 yr 65 yr NS Gender 62% Male 74 % Male p=.05 LOS 6.4 days 9.6days p= .05 83% Cath 94% Cath p = .05 Mean time to Cath: 16 hr 57.6 hr p = .01 In Hospital Mortality: 6.4% 4 % NS CABG: 15% 26% p= .04. Conclusions: The ED groups for N-STEMI were well matched for Demographics. The Delayed Diagnostic Group had delays to discovery of critical lesions (Cath) and Greater Rates of Need for CABG with Longer Hospital Stay. Better early detection protocols and testing are needed.