The number of patients with non-varicose acute gastrointestinal bleeding who need anticoagulants has increased in the last decade. The choice of method and amount of safe therapy in case of acute gastrointestinal bleeding is complicated. A reasonable optimal balance of therapy between hypo- and hypercoagulant components was determined on the basis of an objective assessment of risk factors for re-bleeding and thromboembolic complications. A council of surgeons, resuscitators and cardiologists decided on the rationality of anticoagulant therapy and its scope. With a low risk of recurrent bleeding and a high risk of thromboembolic complications, hemostatic therapy (tranexamic acid, ethamsylate) was combined with the introduction of low molecular weight heparin (bemiparin) in prophylactic doses. An important parameter for the appointment of conservative therapy were thromboelastography. The data obtained indicate the safety of hemostatic and thromboprophylactic therapy (the level of re-bleeding did not differ from the level of bleeding without the use of low molecular weight heparins, according to the literature). Stroke was observed in only 1 patient. The complexity, multifactorial and diversity of clinical conditions of patients with acute gastrointestinal bleeding indicates the need for further study of the treatment problem.

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.

Background Although anesthesiologists are one of the leaders in patient safety, anesthesia in low and low-middle income countries still need improvement in safety mesures with evidence-based practice application. The study aim was to audit the safety principles implementation in the Ukrainian anesthesiologist`s practice. Methods The study was held in March 2021-Februrary 2022 by filling out an online questionnarie. The link to the survey was distributed through Ukrainian Anesthesiologists Association (UAA) members emails and also published on UAA webpage and facebook page. The email was sent to 1000 UAA members. Results Summary 210 respondents took part in the study. Among the respondents, 79.1% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology, but only 40,3% declared that the principles of this Declaration had been implemented in their medical institutions. Even though most of the respondents declared that the quality of the work has improved with the application of the Helsinki Declaration, 16% stated, that there is no positive impact. Most of the medical institutions include mandatory perioperative monitoring, while 17% of hospitals have no access to pulse oximetry for all patients in the operating room and intensive care unit. Concerning using clinical protocols, the one on the treatment of massive bleeding is used in 60.3% of cases, on infection control in 60.5%. In relation to checklists, 28.2% of respondents have never heard about the WHO Safe Surgery checklist. Checklists for equipment inspection are used in only 27.8% of medical institutions. 72.8% hospitals keep records of anaesthesia complications. Conclusion The study showed that significant positive steps are being taken to improve patient safety in Ukraine, where most hospitals comply with the minimum standarts of monitoring during anesthesia. Although there are many challenges for improvement, more hospitals need to implement WHO Safe Surgery and equipment checklists, protocols etc. These areas are a priority for further development in Ukraine. Trial registration Clinicaltrials.gov NCT05175976 on 04/01/2022.

Удельный вес пациентов с неварикозными острыми желудочно-кишечными кровотечениями, требующих применения антикоагулянтов, увеличивается в последнее десятилетие. Выбор способа и объема безопасной терапии при возникновении острых кишечно-желудочных кровотечений усложняется. Работа посвящена определению обоснованного оптимального баланса между гипо- и гиперкоагуляцией на основе объективной оценки рисков.