FEATURES OF TREATMENT TACTIC AND PHYSICAL THERAPY, AND IMMUNE SYSTEM SPECIFICS IN ULCERATIVE GASTRODUODENAL BLEEDING COMPLICATED BY CARDIOVASCULAR PATHOLOGY

Abstract

A retrospective analysis of the treatment data of 635 patients aged 61 to 89 years with gastroduodenal ulcerative bleeding was demonstrated in this study. 565 (89 %) patients included in the first group received classical treatment – monoantiplatelet therapy (MAT), including inhibitors of hypertensive enzymes, beta-blockers, blockers of calcium channels and diuretics. The second group consisting of 70 (11%) patients received dual antiplatelet therapy (DAT). Anticoagulants acting directly or indirectly or warfarin and anticoagulants together with the aforementioned hypotensive component are included in the treatment method. In all patients, local hemostasis was assessed using esophagogastroduodenoscopy. The level of blood interleukins (interleukin-6, interleukin-10, tumor necrosis factor-α (TNF-α), transforming growth factor-1 (TGF-1)) was determined. Complications with bleeding or unstable homeostasis were more common among patients who received DAT (70 people – 11,0%). 21 (3,2%) patients underwent emergency surgery due to active ongoing bleeding. Postoperative mortality was 13,6%. Conservative treatment without surgical interventions was carried out in 96,6% of patients. In patients with acute cardiovascular pathology, only palliative methods of surgical treatment of gastroduodenal bleeding were used. Individuals receiving dual antiplatelet therapy, in whom gastrointestinal bleeding was combined with severe pathology of the circulatory system, had the most significant percentage of massive blood loss. Changes in the level of cytokines in this category of patients correlate with the severity of the disease.