Prevention of thrombosis in patients with gastrointestinal bleedings, anticoagulant therapy: literature review
Keywords:review, gastrointestinal bleedings, thrombosis prophylaxis
Background. Analysis of the causes of unfavorable outcomes in gastrointestinal bleedings shows that one of the directions in improving the results of treatment of such patients is not only improving the methods of non-operative (endoscopic + drug) hemostasis, but also predicting the risk of recurrent bleeding, prevention and treatment of thromboembolic complications. Objective: to study the risks of thromboembolic complications in patients with gastrointestinal bleedings and the prospects for anticoagulant therapy. Materials and methods. The review analyzes the results of clinical studies investigating the risks of thromboembolic complications, clarification of risk groups, volumes and methods of prevention; identifies the most promising effective and safe methods. The critical analysis was carried out based on the study and systematization of scientific researches presented on specialized medical sites. Results. The basis for a reasonable determination of the risk of thrombotic complications in patients with gastrointestinal bleedings is an objective assessment of the balance between the mechanisms of bleeding and thrombosis. Prevention of thromboembolic complications in patients with gastrointestinal bleedings is carried out taking into account individual characteristics. The therapy should consider risk factors both for the development of rebleeding and thromboembolic complications. Thromboelastography is a modern and adequate method for monitoring blood homeostasis at all stages of treatment. Conclusions. A multidisciplinary approach with the participation of surgeons and anesthesiologists is required to make a decision on the prescription, scope and methods of therapy. Such a decision must be justified, taking into account many factors. It is important to consider the mechanisms of action of hemostatic and anticoagulant drugs. Consideration and systematization of all these data does not exclude, but, on the contrary, provides an individual approach to each patient, the determination of an individual strategy with an optimal ratio of the risks of developing rebleeding and prevention of thromboembolic complications.
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