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Gastrointestinal bleeding in patients with acute myocardial infarction: literature review

https://doi.org/10.21626/vestnik/2020-3/02

Abstract


Currently, diseases of the circulatory system are the leading cause of death. A particular problem of a modern multidisciplinary hospital is the combination of acute coronary syndrome (ACS) with gastrointestinal bleeding (GIB), since it is characterized by a syndrome of mutual burdening and mutually exclusive approaches to treatment. The development of GIB in patients with ACS increases the mortality rate of patients to 50-80%. Despite the practical importance of this problem, today there are no clear recommendations and uniform principles for managing patients with such a unique scenario. The review describes in detail the reasons for the development of GIB in patients with ACS, discusses the mechanisms of action of drugs used in ACS and their importance in the development of GIB. It was found that the incidence of GIB in patients undergoing percutaneous coronary interventions reaches 4%, and the risk of re-bleeding doubles. The options for the treatment of GIB are considered: the role of endoscopic and drug hemostasis, as well as X-ray endovascular embolization of the gastric arteries, is shown as a minimally invasive alternative to traditional surgical intervention. Indications for discotinuation of dual antiplatelet therapy based on an objective assessment of the severity of bleeding have been formulated. Much attention is paid to the issue of prevention of GIB in patients with ACS. Risk factors for hemorrhagic complications were considered, and the risk assessment of possible GIB using the BARC scale was shown.

About the Authors

Leonid A. Otdelnov
Privolzhsky Research Medical University
Russian Federation
PhD in Medicine, Associate Professor of the Department of Surgery named after B.A. Korolev
Competing Interests: канд. мед. наук, доцент кафедры госпитальной хирургии им. Б.А. Королёва


Aleksey S. Mukhin
Privolzhsky Research Medical University
Russian Federation
DM, Professor, Head of the Department of Surgery named after B.A. Korolev


Anastasya M. Mastyukova
Privolzhsky Research Medical University
Russian Federation
Resident of the Department of Surgery named after B.A. Korolev


Yuliya E. Tsyganova
Privolzhsky Research Medical University
Russian Federation
Resident of the Department of Faculty and Polyclinic Therapy


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Review

For citations:


Otdelnov L.A., Mukhin A.S., Mastyukova A.M., Tsyganova Yu.E. Gastrointestinal bleeding in patients with acute myocardial infarction: literature review. Kursk Scientific and Practical Bulletin "Man and His Health". 2020;(3):11-19. (In Russ.) https://doi.org/10.21626/vestnik/2020-3/02

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