Performing surgical interventions on the mitral valve is one of the main high-tech treatment methods that requires further anticoagulation therapy. However, patients at high risk of bleeding have traditionally become a group requiring a personalized approach and, in many cases, the guidance of a multidisciplinary team of specialists of various profiles. In this clinical case, it is noteworthy that the 72-year-old patient underwent a full amount of preoperative preparation, and no contraindications to surgical treatment were identified. During esophagogastroduodenoscopy, an endoscopic picture of non-erosive reflux esophagitis, grade M (Minimal), was determined against the background of cardia insufficiency. After surgical treatment, on the background of anticoagulant therapy, vomiting of "coffee grounds" and melena were noted. According to the esophagogastroduodenoscopy data, multiple erosive and ulcerative defects of the stomach and duodenum were revealed, and combined endoscopic hemostasis was performed. The patient was prescribed anti-ulcer eradication therapy. The purpose of this clinical case is to emphasize the importance of a personalized approach to the treatment of this group of patients, who often require consultation with a gastroenterologist.