Prevention of gastrointestinal bleeding in patients with atrial fibrillation receiving oral anticoagulants: Whom? When? How?

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Abstract

Article discusses the possibilities of protecting tunica mucosa of the gastrointestinal tract (GIT) and preventing gastrointestinal bleeding (GB) in patients with atrial fibrillation (AF) receiving oral anticoagulants. In December 2021, the first in our country «Expert consensus on reducing the risk of gastrointestinal bleeding in patients receiving oral anticoagulants» was published. It formulated criteria for a high risk of gastrointestinal bleeding, substantiated the need to protect gastrointestinal tunica mucosa while taking anticoagulants, and proposed an algorithm for gastrointestinal bleeding risk estimation and the choice of gastroenteroprotective therapy. For gastrointestinal bleeding prevention experts recommend proton pump inhibitors and rebamipide. Based on this document, the article discusses the possibilities of gastrointestinal tract protection on certain clinical examples: 1) in a patient with a permanent form of AF, a history of peptic ulcer and GB in anamnesis; 2) in a patient with paroxysmal AF who had an acute myocardial infarction with ST segment elevation and primary percutaneous coronary intervention and receiving dual antiplatelet therapy for 12 months; 3) in a female patient with permanent AF and osteoarthritis, for which she regularly takes NSAIDs.

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About the authors

Natalya M. Vorobyeva

Russian Gerontological Scientific and Clinical Center – economically autonomous structural subdivision of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Author for correspondence.
Email: natalyavorobjeva@mail.ru
ORCID iD: 0000-0002-6021-7864

MD, Senior Researcher at the Laboratory of Clinical Pharmacology and Pharmacotherapy

Russian Federation, Moscow

Irina P. Malaya

Russian Gerontological Scientific and Clinical Center – economically autonomous structural subdivision of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: malaya_ip@rgnkc.ru
ORCID iD: 0000-0001-5964-5725

PhD in Medical Sciences, Head of the Laboratory of Clinical Pharmacology and Pharmacotherapy

Russian Federation, Moscow

Ekaterina R. Alimova

Russian Gerontological Scientific and Clinical Center – economically autonomous structural subdivision of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: alimova_er@rgnkc.ru
ORCID iD: 0000-0002-4497-1277

Junior Researcher at the Laboratory of Cardiovascular Aging

Russian Federation, Moscow

Olga N. Tkacheva

Russian Gerontological Scientific and Clinical Center – economically autonomous structural subdivision of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: tkacheva@rgnkc.ru
ORCID iD: 0000-0002-4193-688X

MD, Professor, Corresponding Member of RAS, Director

Russian Federation, Moscow

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