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To the Editor:It is a challenge for a physician to manage acute ST-elevation myocardial infarction (STEMI) in a patient with upper gastrointestinal bleeding.We present a case of gastrointestinal bleeding due to antiplatelet therapy after percutaneous coronary intervention (PCI) and secondary in-stent thrombosis due to discontinuation of antiplatelet drugs.The experience of treatment of this case may shed some light on antiplatelet therapy in this clinical dilemma for patients with both high bleeding and high ischemia risk.