American Board of Internal Medicine (ABIM) Certification Practice Exam

What can de-escalating preoperative aspirin therapy in patients with upper GI bleeding do?

1. Lower the risk of rebleeding

2. Increase cardiovascular complications

3. Decrease gastrointestinal symptoms

4. Eliminate the need for gastroenterology consultation

The correct answer is: Lower the risk of rebleeding

De-escalating preoperative aspirin therapy in patients with upper gastrointestinal (GI) bleeding can lower the risk of rebleeding. This is significant because aspirin can contribute to the irritation and bleeding within the GI tract, especially in individuals who may have a predisposition to bleeding or lesions in the stomach or duodenum. By reducing or temporarily halting aspirin therapy prior to surgical intervention, healthcare providers can minimize the possibility of exacerbating any bleeding tendencies, which is crucial for ensuring a safer surgical outcome and reducing postoperative complications related to bleeding. While the other options may seem plausible, they do not accurately reflect the primary benefit of de-escalating aspirin therapy in this context. For instance, cardiovascular complications could actually increase if aspirin is abruptly discontinued in patients who are at high risk for such events; thus, careful management is essential. Additionally, while gastrointestinal symptoms may improve with a reduction in aspirin use, the main concern in the context of surgery is the risk of rebleeding. Lastly, the need for gastroenterology consultation may still remain imperative depending on the clinical circumstances surrounding the upper GI bleeding.