Aspirin/ticagrelorHaemoperitoneum and hepatic subcapsular haematoma: 2 case reports In a case series, a 48-year-old woman and a 39-year-old woman were described, who developed haemoperitoneum or subcapsular haematoma during antiplatelet therapy with aspirin or ticagrelor [routes and durations of treatment to reactions onset not stated].Case 1: The 48-year-old woman had a history of hypertension, cardiovascular disease and end stage renal disease, which was treated with peritoneal dialysis, since August 2019. She was admitted due community-acquired pneumonia. Her regular medications included dual anti-platelet therapy, which consisted of aspirin 81mg daily and ticagrelor 90mg twice daily. During admission, she underwent continuous ambulatory peritoneal dialysis (CAPD). On day 1, she developed cardiac arrest, for which she required cardiopulmonary resuscitation (CPR). Peritoneal dialysis was held during that time and then resumed on day 2. At that time, the effluent was observed to be grossly haemorrhagic and haematocrit dropped from 41% to 28%. Analysis of PD fluid showed 664,149 red blood cells (RBC)/mm 3 . For the management of anaemia due to blood loss, she received RBC transfusion. The contrastenhanced CT-scan revealed a large left hepatic subcapsular haematoma, which was managed after consultation with surgery team. Her clinical presentation was consistent with haemoperitoneum secondary to hepatic subcapsular haematoma, which was associated with her antiplatelet therapy. Hence, the anti-platelet therapy was discontinued. Due to severity of haemoperitoneum, she was switched to haemodialysis. Consequently, she became clinically stable with stabilisation of anaemia. She was discharged on day 19 and was managed successfully with peritoneal dialysis in the ambulatory setting.Case 2: The 39-year-old woman had a history of hypertension, diabetes mellitus, cerebrovascular disease as well as ESRD, for which she had been treated with ambulatory peritoneal dialysis since 2018. In July 2020, she was hospitalised due to COVID-19 pneumonia. Her home medication included aspirin 81mg once daily. On hospital day 3, she was transferred to the ICU due to hypoxia and respiratory failure. On day 5, she developed cardiac arrest, for which she received cardiopulmonary resuscitation. Peritoneal dialysis was re-initiated on the next day. During dialysis, she was noted to be haemodynamically unstable and thus required vasopressor support. Her haematocrit decreased from 30% to 19.7% which required RBC transfusion. She was diagnosed with haemoperitoneum and temporarily switched to intermittent haemodialysis considering the severity of bleeding. The occurrence of haemoperitoneum was associated with aspirin. Hence, aspirin was discontinued. Consequently, her haemtocrit stabilised at 29%. She was transitioned back to peritoneal dialysis on day 9 of hospital admission, which was well-tolerated. However, her course was complicated by anoxic encephalopathy and she eventually died on day 16.
