PEG placement-related bleeding risk minimal in patients on uninterrupted antithrombotic therapy

Patients on uninterrupted periprocedural antithrombotic therapy have a negligible risk of significant bleeding associated with the placement of a percutaneous endoscopic gastrostomy (PEG) tube, a recent study has shown.

The investigators collected data regarding demographics, diagnoses, comorbidities, and clinical outcomes pertinent to PEG from 2010 to 2016. They also analysed data on antithrombotic therapy along with the rate of minor or major complications, including bleeding, associated with this procedure.

Significant bleeding was characterized as postprocedure bleeding from PEG site warranting a blood transfusion or surgical/endoscopic intervention.

Overall, 1,613 consecutive PEG procedures were included in the analysis, with 1,540 (95.5 percent) patients receiving some form of uninterrupted antithrombotic therapy. Of the patients, 535 (34.7 percent) were on aspirin, 256 (16.6 percent) on clopidogrel, and 119 (7.7 percent) on both aspirin and clopidogrel.

Subcutaneous heparin, intravenous heparin, warfarin, and direct-acting oral anticoagulation (DOAC) were uninterrupted in 980 (63.6 percent), 34 (2.1 percent), 168 (10.9 percent), and 82 (5.3 percent) patients, respectively, who overlapped on multiple drugs.

Six significant bleeding events occurred in the entire cohort (0.39 percent), all of which were in subcutaneous heparin group either alone or in combination with aspirin. No clinically significant bleeding was observed in patient on uninterrupted aspirin, warfarin, clopidogrel, or DOAC groups.

Of note, only five patients (0.31 percent) had mortality associated with PEG.

“Antithrombotic therapy is often interrupted before the placement of a PEG tube because of potentially increased risk of haemorrhagic events,” the investigators said.