Bleeding after percutaneous endoscopic gastrostomy is linked to serotonin reuptake inhibitors, not aspirin or clopidogrel.

Academic Article

Abstract

  • BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an invasive procedure that can result in bleeding. Guidelines recommend discontinuing clopidogrel for 7 to 10 days, but not withholding aspirin, before PEG. Serotonin reuptake inhibitors (SRIs) have been associated with an increased risk of GI bleeding. OBJECTIVE: To determine whether there is an association between periprocedural aspirin, clopidogrel, or SRI use and bleeding in patients who underwent PEG tube placement. DESIGN: Retrospective cohort study. SETTING: Large quaternary-care academic medical center. PATIENTS: A total of 990 patients (525 men) with a median age of 69.8 years who underwent PEG from January 1999 to April 2009. INTERVENTIONS: PEG tube placement. MAIN OUTCOME MEASUREMENTS: GI bleeding. RESULTS: Sixteen patients (1.6%) had evidence of bleeding during the first 48 hours after PEG, and 12 patients (1.2%) had evidence of bleeding between 48 hours and 14 days after PEG. Thirty-six patients (3.6%) received high-dose aspirin (>325 mg), 27 patients (2.7%) received clopidogrel (75 mg), and 99 patients (10%) received an SRI before PEG. Twenty-four patients (2.4%) received high-dose aspirin, 25 patients (2.5%) received clopidogrel, and 130 patients (13.1%) received an SRI after PEG. Multivariate analysis demonstrated no association between periprocedural use of aspirin (at any dose) or clopidogrel and post-PEG bleeding. However, SRIs administered 24 hours or less before PEG were associated with a significantly higher odds of post-PEG bleeding (adjusted odds ratio 4.1; 95% CI, 1.1-13.4; P = .04). LIMITATIONS: Retrospective, single-center study with limited statistical power despite a relatively large cohort of patients. CONCLUSIONS: Use of aspirin or clopidogrel before or after PEG was not associated with procedure-related bleeding. SRI use in the 24 hours before PEG was associated with an increased risk of bleeding.
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    Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Aspirin, Clopidogrel, Cohort Studies, Female, Gastrointestinal Hemorrhage, Gastroscopy, Gastrostomy, Humans, Male, Middle Aged, Retrospective Studies, Serotonin Uptake Inhibitors, Ticlopidine, Time Factors, Young Adult
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    Author List

  • Richter JA; Patrie JT; Richter RP; Henry ZH; Pop GH; Regan KA; Peura DA; Sawyer RG; Northup PG; Wang AY
  • Start Page

  • 22
  • End Page

  • 34.e1
  • Volume

  • 74
  • Issue

  • 1