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Answer 2
  1. The addition of indomethacin to his regimen. Indomethacin is a potent nonsteroidal anti-inflammatory medication, and the ulcerogenic effects of such medications are well established. Given that the patient was also taking an oral anticoagulant (warfarin), it is not surprising that he developed a significant episode of GI bleeding from gastric ulcers. The addition of an oral PPI to the patient’s regimen as GI prophylaxis would likely have avoided this situation. Given the patient’s medical history, it would have been inappropriate to stop warfarin, the ACE inhibitor, or calcium channel blocker before starting therapy for gout. Colchicine is not typically associated with the development of gastric ulcers.

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