Prevention Of Gastrointestinal Bleeding Research Articles

Systematic review of self-assembling peptides as topical agents for treatment and prevention of gastrointestinal bleeding.

Gastrointestinal bleeding is a significant and potentially lethal event. We aimed to review the efficiency and safety of self-assembling peptides for the treatment and prevention of gastrointestinal tract bleeding. We conducted a systematic search for studies describing the endoscopic use of self-assembling peptides for treatment or prevention of bleeding in the gastrointestinal tract in a parallel, independent fashion. The primary outcomes were rates of successful initial hemostasis, delayed bleeding, and rebleeding. The secondary outcomes were adverse events and ease and volume of gel used. Seventeen studies were analyzed. Overall success rate of self-assembling peptides in gastrointestinal bleeding was 87.7% (38%-100%), regardless of etiology or associated treatments. Rebleeding rate ranged from 0% to 16.2%, with a mean of 4.7%, and overall delayed bleeding rate was 5% (range, 0%-15.9%). Only three adverse events were reported in a pooled number of 815 patients. The volume of gel used varied (0.43 to 3.7 mL) according to indication and type of bleeding. The limited available data on the use of self-assembling peptides in gastrointestinal endoscopy suggest a high efficiency and good safety profile.

A review on increasing risk for gastrointestinal bleeding associated with dabigatran

Dabigatran, a reversible direct thrombin inhibitor, is widely used in clinical practice as a therapeutic option due to its unique mechanism of action in comparison to other anticoagulants. Although patients taking dabigatran experience a reduced risk of fatal bleeding, a higher risk of gastrointestinal bleeding (GIB) is associated with dabigatran, and its rational use between anticoagulation and bleeding is challenging for clinicians. To prevent GIB, it is imperative for clinicians to understand the pharmacological characteristics of dabigatran to ensure that its prescription should be avoided in patients with bleeding. In this review, we summarize the mechanism of action and pharmacokinetics of dabigatran and bleeding sites in the gastrointestinal tract in patients treated with dabigatran, as well as discuss the factors that increase the risk of dabigatran-induced GIB, including dose, age, drug interactions, race, genetics and past medical history. Finally, the treatment and prevention of GIB with dabigatran is also discussed. This review will help clinicians choose their drugs and doses more carefully for treating GIB.

Reduced risk of gastrointestinal bleeding associated with eupatilin in aspirin plus acid suppressant users: nationwide population-based study.

Mucoprotective agents, such as eupatilin, are often prescribed to prevent gastrointestinal (GI) bleeding in addition to an acid suppressant despite the absence of a large-scale study. We evaluated the additional effect of eupatilin on the prevention of GI bleeding in both the upper and lower GI tract in concomitant aspirin and acid suppressant users using the nationwide database of national claims data from the Korean National Health Insurance Service (NHIS). An aspirin cohort was constructed using the NHIS claims data from 2013 to 2020. Patients who manifested with hematemesis, melena, or hematochezia were considered to have GI bleeding. A Cox proportional hazards regression model was used to determine the risk factors for GI bleeding associated with the concomitant use of GI drugs and other covariates among aspirin users. Overall, a total of 432,208 aspirin users were included. The concurrent use of an acid suppressant and eupatilin (hazard ratio [HR] = 0.85, p = 0.016, vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding. Moreover, a more than 3-month duration (HR = 0.88, p = 0.030) of acid suppressant and eupatilin prescription (vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding. Eupatilin administration for ≥ 3 months showed additional preventive effect on GI bleeding in concomitant aspirin and acid suppressant users. Thus, cotreatment with eupatilin with a duration of 3 months or longer is recommended for reducing GI bleeding among aspirin plus acid suppressant users.

S1299 Safety and Efficacy of Self-Assembling Peptide Gel in Prevention of Gastrointestinal Bleeding After Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection: A Single Center Experience

S1299 Safety and Efficacy of Self-Assembling Peptide Gel in Prevention of Gastrointestinal Bleeding After Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection: A Single Center Experience

Prevention of Gastrointestinal Bleeding in Patients Operated on Coronary Arteries for Acute Coronary Syndrome

Introduction. Acute coronary syndrome is a collective concept that reflects any form of exacerbation of coronary heart disease from unstable angina to acute myocardial infarction. Modern principles for the diagnosis and treatment of this syndrome are coronary angiography and urgent stenting of the affected coronary artery. These patients, having survived a life-threatening condition and surgical treatment, have a high probability of acute erosive and ulcerative gastroduodenal lesions and dependent gastrointestinal lesions. As a result, conservative treatment of acute ulcers and erosions complicated by bleeding remains unsatisfactory, mortality ranges from 36.4 to 50-80%.The aim of the study was to evaluate effectiveness of the proposed measures to prevent erosive and ulcerative lesions of the stomach and duodenum and gastrointestinal bleeding in patients with acute coronary syndrome who underwent coronary artery stenting.Materials and methods. The study included 614 patients who underwent percutaneous coronary intervention and stenting of the arteries of the heart due to the development of acute coronary syndrome. The patients were divided into two groups. The first group included 284 patients treated in 2018. Prevention of acute erosive and ulcerative gastroduodenal lesions was not routinely performed in this group. The second group included 330 patients treated in 2019. All patients in this group underwent prophylaxis and included omeprozole 40 mg per day from the first hours of the patient's stay in the hospital.Results. During the entire study period, 31 patients died in the early and late postoperative period in the first group, 18 of them during the first hospitalization. In the second group, 35 patients died during the entire study period in the early and late postoperative period, 21 of them during the first hospitalization. With the development of gastrointestinal bleeding, the probability of a full recovery in a patient with acute coronary syndrome is extremely low, and the system of preventive measures avoids this problem.Conclusion. Prevention of stressful acute erosive and ulcerative gastroduodenal lesions due to use of intravenous proton pump inhibitors in increased dosages (omeprozole 40 mg per day) is indicated to the patients of the studied group; in the presence of additional risk factors, the prophylactic dosage of proton pump inhibitors is doubled (omeprozole 40 mg 2 times a day). Mandatory non-invasive diagnosis of Helicobacter pylori for all patients is also indicated; if the condition is detected, eradication therapy is to be carried out. It is also required to apply proton pump inhibitors for the entire period of dual antiplatelet or anticoagulant therapy.

Prevention of gastrointestinal bleeding in patients operated on the arteries of the lower extremities for critical ischemia

The purpose of the study. To determine the frequency of occurrence and prevention measures of erosive and ulcerative lesions of the proximal gastrointestinal tract in patients operated for critical ischemia with a diagnosis of obliterating atherosclerosis of the arteries of the lower extremities. Materials and methods. The examination included patients with lower limb ischemia - III-IV stage of ischemia according to the Fontaine-Pokrovsky classification. The patients were divided into 2 groups: the control group, where treatment was carried out according to the recommendations: HP diagnosis (express test) was carried out only with an endoscopic picture of gastric ulcer and duodenal ulcer, as well as the main group, in which HP diagnosis was carried out totally with fibrogastroduodenoscopy and a standard three-component eradication scheme was prescribed for at least 14 days when bacterial contamination of the gastric mucosa was detected. Results. In all cases, endoscopic changes characteristic of gastritis were registered in patients of the first group. Of the eight patients (100%), two (25%) were diagnosed with single erosions in the distal parts of the stomach, one patient (12.5%) had atrophic gastritis, and the remaining 5 (62.5%) patients had hyperemia of the antral and prepiloric mucosa. In patients of the second group, there were no changes in FGDS in one patient (25%), foci of mucosal atrophy were diagnosed in two patients (50%), and single erosions in one (25%). Conclusion. Among patients with peripheral artery diseases accompanied by critical ischemia, by the time they seek specialized medical care, there are no healthy or close to such persons with unchanged mucous membrane of the proximal parts. In the high-risk groups for the occurrence of gastrointestinal bleeding, a complex effect on aggression factors is necessary

The role of polyglycolic acid sheets in the management of post-endoscopic submucosal dissection gastrointestinal bleeding and esophageal stricture: A PRISMA compliant systematic review and meta-analysis.

Background:As a relatively minimally invasive technique, endoscopic submucosal dissection (ESD) is widely used for the treatment of gastrointestinal lesions. However, it is associated with complications, such as postoperative bleeding, stricture, and perforation. A covering method using polyglycolic acid (PGA) sheets for ESD-induced ulcers has been reported to be effective in reducing the risk of post-ESD bleeding and esophageal stricture. Herein, we conducted a systematic review and meta-analysis to evaluate the role of PGA sheets in the prevention of gastrointestinal bleeding and esophageal stricture after ESD.Methods:We searched PubMed, Web of Science, and the Cochrane Library databases on October 15, 2019. All eligible articles were selected based on the predefined inclusion and exclusion criteria. The main outcomes were the rates of post-ESD gastrointestinal bleeding and esophageal stricture. Cochrane’s Q statistic and I2 test were used to identify heterogeneity between the studies. When there was no obvious heterogeneity (I2 < 50%, P > .1), a fixed-effect model was used. When there was obvious heterogeneity (I2 > 50%, P < .1), a random effect model was used. Funnel plots and the Egger regression test were used to assess publication bias.Results:Fifteen articles were included in the meta-analysis, of which 7 were exclusively about the use of PGA sheets to prevent postoperative gastrointestinal bleeding, and the remaining reported the use of PGA sheets to prevent postoperative esophageal stenosis. Our analysis showed that preventive therapy with PGA sheets decreased the rates of post-ESD gastrointestinal bleeding (risk ratio [RR] = 0.35, 95% confidential interval [CI]: 0.19–0.64, P < .001) and esophageal stricture (RR = 0.46, 95% CI: 0.27–0.79, P = .005), and the gastrointestinal bleeding and esophageal stricture rates after preventive treatment with PGA sheets were 5.7% (95% CI: 3.6%–8.8%) and 20.6% (95% CI: 14.5%–28.4%), respectively.Conclusion:The utilization of PGA sheets after ESD has an excellent outcome in reducing the risk of postoperative gastrointestinal bleeding and esophageal stricture.

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

Background: The incidence of gastrointestinal bleeding in patients with severe burns can reach up to 10%.Objective: Evaluation of the risk factors for gastrointestinal bleeding and of the effectiveness of stress ulcer prophylaxis in patients with severe burns receiving proton pump inhibitors.Material and methods: The study included the results of treatment of 270 patients with burns more than 10% of total body surface area (TBSA), in whom 13 potential risk factors for gastrointestinal bleeding were studied. All patients received omeprazole therapy with 40 mg № 1 intravenous or 20 mg № 2 orally. The data obtained were processed in Microsoft Office Excel 2007 and IBM SPSS 20.0.Results: Significant risk factors for gastrointestinal bleeding were hypotension requiring treatment with vasopressors (dopamine ≥ 10 μg/kg/min or norepinephrine ≥ 0.5 μg/kg/min) for 2 or more days (χ2 = 5.126; p = 0.024) and full thickness burns with more than 50% of total body surface area (χ2 = 7.031; p = 0.008). The incidence of gastrointestinal bleeding was 4%. These bleedings were hemodynamically insignificant; in all cases, acute ulcers were the cause for them. There were no recurrences of bleeding and no repeated endoscopy or surgical treatment was required. The developed bleeding did not have a significant effect on mortality.Conclusion: Using proton pump inhibitors minimizes the frequency and intensity of gastrointestinal bleeding and also prevents lifethreatening complications during their development. More complex prevention of stress ulceration is necessary for patients with full thickness burns more than 50% of TBSA which develop hypotension requiring long‑term vasopressor therapy.

Вплив основних положень «Міжнародних настанов з інтенсивної терапії тяжкого сепсису і септичного шоку — 2012» на тлі локальної внутрішньопросвітної реоксигенації перфтораном на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганно

У роботі проведено аналіз результатів впливу ключових питань діагностики та інтенсивної терапії сепсису, що базуються на положеннях «Міжнародних настанов з інтенсивної терапії тяжкого сепсису і септичного шоку — 2012», доповнених локальною внутрішньопросвітною реоксигенацією перфтораном, на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганної недостатності. Висновки базувалися на підставі динаміки кількісних характеристик фізіологічного патерну CI-DO2-VO2; pH інтрамукозного; шкал GCS, APACHE II, SOFA; показників синдрому системної запальної відповіді, концентрації цитокінів (TNFα, IL-1, ­IL-4, IFNα), імуноглобулінів (IgA, IgM, IgG). Відновлення показників фізіологічного патерну DO2-VO2 до наднормальних значень до 3-ї доби сприяло поліпшенню загальної та регіональної оксигенації; швидкому оборотному розвитку церебральної недостатності: кількість балів становила 13,83 і коливалась клінічно між помірним оглушенням і ясною свідомістю; реєструвалась відсутність проявів SIRS; вірогідному зниженню концентрацій прозапальних цитокінів і відновленню їх рівноваги з протизапальним IL-4. Відсутність фази повторного погіршення стану хворих асоціювалася з обмеженням гострого медіатозу, подальшим регресом проявів гастроінтестинальної недостатності. Запобігання шлунково-кишковим кровотечам свідчить про прискорення репаративної регенерації ентероцитів під впливом перфторану. Початково передбачувана летальність за сумою балів шкали APACHE II становила 51 %, істинна летальність — 25 %, локальна реоксигенація перфтораном призвела до зниження летальності на 26 %.

Вплив основних положень Міжнародного керівництва з інтенсивної терапії тяжкого сепсису та септичного шоку — 2012 із додатковою ентеропротекцією на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганної недостатності

У статті проведено аналіз результатів впливу ключових положень Міжнародного керівництва з інтенсивної терапії тяжкого сепсису та септичного шоку — 2012, доповнених ентеропротекцією, на перебіг септичного процесу і вираженість енцефалопатії в структурі поліорганної недостатності. Заключення аналізу базувалося на підставі динаміки кількісних характеристик фізіологічного патерну CI-DO2-VO2; рН інтрамукозного, шкал GCS, APACHE II, SOFA; показників синдрому системної запальної відповіді; концентрації цитокінів (TNF-α, IL-1, IL-4, IFN-α); імуноглобулінів (IgA, IgM, IgG). Незважаючи на відновлення загальної оксигенації в умовах супранормальних значень DO2-VO2, на 3-тю — 5-ту добу відмічали чотири критерії SIRS, що розцінювалося як імовірність ризику уповільненої регресії синдрому запальної відповіді в подальшому. Сказане вище знайшло своє підтвердження в клінічному показнику лейкоцитів на 7-му добу — 15,18 • 109/л і незрілих форм — 11,88 %. Бали за шкалами APACHE II і SOFA, знизившись порівняно з такими на 5-ту добу, «застигли» на цьому рівні на 7-му добу. Неврологічна симптоматика на 7-му добу оцінювалася як сопор — 10,88 бала. Максимально високі концентрації прозапальних цитокінів на 5-ту — 7-му добу можна пояснити їх реперфузійним походженням після відновлення спланхнічного кровообігу. При цьому позитивним було перевищення IL-4 на 7-му добу свого рівня на 5-ту добу на 77,42 %. Використання сорбентів виявилося неефективним за наявності гострих ерозій і виразок шлунково-кишкового тракту для регенерації ентероцитів і запобігання шлунково-кишковим кровотечам навіть у поєднанні з інгібіторами протонної помпи. Початково передбачувана летальність за сумою балів шкали APACHE II становила 51 %, справжня летальність — 35,5 %, тобто застосування ентеросорбенту призвело до зниження летальності на 15,5 %.

Proton Pump Inhibitors: Exploring Cardiovascular Complications and Prescription Protocol.

Proton pump inhibitors (PPIs) are among the most extensively prescribed medications internationally for gastroesophageal reflux disease treatment and the prevention of gastrointestinal bleeding. Their efficiency, ease of availability, and low side effect profile offer several advantages over other treatment modalities. Long-term use and inappropriate prescribing habits have increased the presence of this class of drugs, prompting several studies to reassess their adverse effects. This article explored the possibility of a relationship between PPIs and cardiovascular adverse effects while highlighting the current prescription guidelines for PPIs. We further examined the need for more research into the etiology of PPI-related cardiovascular adverse effects and strategies to alleviate these risks.

Prevention of gastrointestinal bleeding in critically ill patients.

This review focuses on the current literature on the epidemiology and prevention of stress-induced clinically important gastrointestinal bleeding in ICU patients. The incidence of stress-induced clinically important gastrointestinal bleeding in critically ill patients seems to be decreasing. Observational studies and an exploratory randomized controlled trial suggest that early enteral nutrition may be effective in preventing gastrointestinal bleeding in patients who are not at high risk. Recent systemic reviews and meta-analyses indicate that proton pump inhibitors and H2 receptor antagonists are more effective than placebo in preventing clinically important gastrointestinal bleeding, especially in high-risk and very high-risk patients, but do not reduce mortality. Although observational data suggested an association of proton pump inhibitors and H2 receptor antagonists with Clostridium difficile infection and pneumonia, this association was not confirmed in randomized controlled trials. The incidence of stress-induced clinically important gastrointestinal bleeding in critically ill patients seems to have decreased over time. Even though stress ulcer prophylaxis in critically ill patients has been a research focus for decades, many questions remain unanswered, such as which groups of patients are likely to benefit and what pharmacologic agent is associated with the best benefit-to-harm ratio.

Top 10 publications of Intensive Care Medicine journal 2020

COVID-19 pandemic provoked an increasing interest in recent advances in diagnosis and treatment of critical care patients. Among the main problems are the lack of evidence-based guidelines and a growing number of patients with multiple organ dysfunction syndrome. Therefore, indications for the use of previously uncommon intensive care approaches are expanding. These reasons, along with a large pool of non-systematic literature, dictate the need in the narrative review of top 10 recent publications which provide a snapshot of the most relevant research in critical care. These papers overview evidence-based information on the control of acute kidney injury, ventilator-associated pneumonia and sepsis in critically ill patients including those with COVID-19, principles of proper haemodynamic and ventilatory support, timely cessation of antimicrobial therapy, efficient prevention of gastrointestinal bleeding, and the use of the prone position in patients with acute respiratory distress syndrome.

The Use and Misuse of Proton Pump Inhibitors: An Opportunity for Deprescribing

Proton pump inhibitors (PPIs) are proven medications of choice for gastroesophageal reflux disease (GERD), acid-related disorders, erosive esophagitis, Barrett esophagus, prevention of gastrointestinal bleeding while on nonsteroidal anti-inflammatory drugs, eosinophilic esophagitis, peptic ulcer disease, stress ulcer prophylaxis in critically ill patients, and other indications. Best practice guidelines from several sources on the appropriate indications and duration of PPI therapy have been summarized for easy assimilation. Individualized decision with regard to PPI use is illustrated by case vignettes; best approaches are provided.The significant increase in use of PPIs for ill-defined indications over the years, associated adverse outcomes with long-term use, and consequent increase in health care costs have drawn much attention. Adverse outcomes due to PPI therapy may be categorized as unrelated or related to gastric acid inhibition. Examples of outcomes unrelated to acid inhibition include allergic reactions, acute interstitial nephritis, chronic kidney disease, poor cardiovascular outcomes, dementia, and drug interactions; consequences of acid inhibition include gastrointestinal infections, pneumonia, nutrient deficiencies, fractures, spontaneous bacterial peritonitis, and small intestinal bacterial overgrowth.Provider awareness regarding best practice guidelines on PPI use and imparting pertinent education to patients may be the rational approach to safe and effective PPI therapy. In individuals in whom the drug is not indicated, efforts at deprescribing the PPI may be attempted following discussion with the patient. Approaches include stopping the drug, reducing the dose or using “on-demand” therapy after completing the course of treatment for the specific indication. Barriers to successful deprescribing exist. Follow-up is recommended for recurrence of manifestations; in the event of recurrence, the PPI may need to be re-instituted.PPIs are valuable, irreplaceable drugs in the prevention and treatment of certain disorders for specific durations of time. Evidence nevertheless suggests that excessive and inappropriately prolonged use of PPIs is associated with a broad range of adverse effects. Education of provider and patient, stewardship, and motivation are key to appropriate use of PPIs for the right indications. Key implications for practice are offered.

Abstract 15510: Trials of Dual Antiplatelet Therapy Do Not Include Evidence-Based Strategies for Gastrointestinal Bleeding Prevention

Background: Proton pump inhibitors (PPIs) substantially reduce the risk of upper gastrointestinal bleeding (GIB) and are recommended for high-risk patients by professional cardiology societies but remain underused in clinical practice. By reducing hemorrhagic risk associated with dual antiplatelet therapy (DAPT), PPIs may affect the risk-benefit equation of varying durations of DAPT and should be considered in such clinical trials. We sought to determine the extent to which randomized controlled trials (RCTs) evaluating DAPT after percutaneous coronary intervention (PCI) provide guidance on the use of PPIs for GIB prevention. Methods: A previously completed systematic review was updated to identify all RCTs comparing varying durations of DAPT between June 1983 and October 2019. Primary publications, online supplements, clinical trial registries and additional publications linked to the trial registration number were reviewed for protocol information. Results: Of 21 included studies (n=58,625; Figure), none of the study protocols provided guidance on the use of PPIs by trial participants. One study stated that the decision to use PPIs was left to the discretion of the treating physician. Two studies specified that treating physicians could prescribe non-mandated medications concordant with standard of care but did not specifically mention PPIs. Only 5 studies reported rates of PPI use, which ranged from 25.6-69.1%. Conclusions: Trials of DAPT regimens did not provide guidance on the use of PPI gastroprotection, a guideline-supported strategy for prevention of bleeding from the GI tract, the most common site of bleeding in patients using DAPT. Guidance on and reporting of PPI use should be mandatory in future antithrombotic trials to enhance their safety and interpretability. Figure 1. PRISMA flow diagram

Modern Approaches to Optimal Antithrombotic Therapy for Stable Ischemic Heart Disease

The article highlights the practical aspects of the use of antithrombotic therapy in patients with stable (chronic) coronary artery disease (САD). The САD verification using modern functional and anatomical diagnostic methods are considered. Patients with stable САD represent a heterogeneous group, having various clinical scenarios. Information is provided on the main risk factors for ischemic and hemorrhagic complications that determine the choice of optimal antithrombotic therapy regimens. Modern views on the monotherapy and clopidogrel in САD are presented. The data of the largest international studies CHARISMA and PEGASUS-TIMI 54 on the use of double antiplatelet therapy in patients with stable IHD reflected in modern guidelines are highlighted. Features of new antiplatelet agents (prasugrel and ticagrelol) are described. Based on the results of the COMPASS study, indications for the administration of small doses of rivaroxaban in combination with aspirin for the secondary prevention of cardiovascular complications in patients with stable manifestations of atherosclerosis with a low risk of bleeding are considered. The use of antithrombotic therapy is associated with an increased risk of bleeding and particularly with gastrointestinal bleeding. The information on the use of drugs for the prevention of gastrointestinal bleeding is provided.Antithrombotic therapy can reduce the risk of complications associated with atherothrombosis, however, to improve prognosis a multipurpose intervention is required, including correction of risk factors and the use of drugs from different groups with proven effectiveness. Optimal medical therapy, including antithrombotic drugs, is vital for patients with САD and can successfully prevent adverse outcomes.

Acid suppression therapy, gastrointestinal bleeding and infection in acute pancreatitis – An international cohort study

BackgroundAcid suppressing drugs (ASD) are generally used in acute pancreatitis (AP); however, large cohorts are not available to understand their efficiency and safety. Therefore, our aims were to evaluate the association between the administration of ASDs, the outcome of AP, the frequency of gastrointestinal (GI) bleeding and GI infection in patients with AP. MethodsWe initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018. ResultsData of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality. ConclusionsAlthough ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP.

Gastro-duodenal risks during therapy with new oral anticoagulants and possibility of minimizing them

Relevance . One of the main causes of death and disability in the world is thrombotic diseases, the effective means of prevention of which is the use of anticoagulants. However, their purpose is associated with a certain risk, including the development of gastrointestinal bleeding, which can be fatal. The search for ways to minimize the risks of gastrointestinal bleeding in patients taking new oral anticoagulants is an urgent task of clinical medicine. Aim . Analyze literature data to systematize data on risk factors, treatment options and prevention of gastrointestinal bleeding with the use of new oral anticoagulants in patients treated for pulmonary embolism. Materials and methods . A literature review of the data of domestic and foreign authors on the problem of pathogenesis, clinical manifestations, diagnosis, treatment and prevention of damage to the gastrointestinal tract during treatment of pulmonary embolism was conducted. Results . An attempt was made to systematize the literature data on risk factors, prevention and treatment of gastrointestinal bleeding, taking into account the individual characteristics of the patient, based on evidence. The description of their own clinical observation is provided. Conclusions . When prescribing therapy with new oral anticoagulants, it is necessary to consider benefits and risks, take into account the risk factors for gastrointestinal bleeding, keeping in mind the individual characteristics of the patient and work on their prevention.

Gastrointestinal Bleeding in Antithrombotic Therapy in Patients with Coronary Heart Disease: Risk Factors, Pathogenesis and Treatment

Aim. Description of risk factors, pathogenesis and treatment strategies of gastrointestinal bleeding (GIB) in the course of antithrombotic therapy in patients with coronary heart disease (CHD).Key points. Risk factors of GIB during antithrombotic therapy in CHD patients include: GIB, gastric and/or duodenal ulcer in the history, reflux esophagitis, presence of H. pylori, inflammatory bowel disease, diverticula, haemorrhoids, angiodysplasia, gastrointestinal neoplasia, age above 65 years, concomitant treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glomerular filtration rate &lt;50 mL/min, high doses of direct oral anticoagulants (DOACs) ≥3 in HAS-BLED score. Pathogenesis of GIB in the course of antithrombotic therapy is associated with systemic hypocoagulation and local damaging effects of these drugs. Strategies of GIB treatment during DOAC therapy in patients with CHD are determined by severity of bleeding and threat to life. Aside to standard conservative measures, endoscopic or surgical haemostasis requires usage of antidotes to suppress effects of DOACs and other specific drugs in severe cases.Conclusion. GIB associated with antithrombotic therapy in CHD patients poses a serious medical problem of growing importance with wider application of anticoagulant drugs. Antithrombotic therapy requires accurate decision making, risk assessment, careful monitoring of the patient’s condition and timely diagnosis of gastrointestinal disorders following good rationale in GIB prevention.

Some Aspects of Nutritional Nutrition for Early Prevention of Gastrointestinal Bleeding in Burned

Some Aspects of Nutritional Nutrition for Early Prevention of Gastrointestinal Bleeding in Burned