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Upper gastrointestinal haemorrhage is a serious complication of aspirin and clopidogrel (dual) anti-platelet therapy with a high morbidity and mortality. Using an illustrative case this article examines the prognostic significance of gastrointestinal haemorrhage and the risk of stopping anti-platelet therapy. The management of this clinical challenge is reviewed, in the absence of a clinical guideline, with particular reference to the judicious tailoring of anti-platelet therapy, the role of therapeutic endoscopy and the utility of blood transfusion.