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Gastrointest Endosc. 2011 Jul;74(1):22-34.e1. doi: 10.1016/j.gie.2011.03.1258.

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

Author information

1
University of Virginia, Charlottesville, VA, USA.

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.

PMID:
21704806
DOI:
10.1016/j.gie.2011.03.1258
[Indexed for MEDLINE]

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