Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis

Background and aim: Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment...

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Main Authors: Alfredo J. Lucendo, Tomás Sánchez-Casanueva, Olga Redondo, José M. Tenias, Ángel Arias
Format: Article
Language:English
Published: Aran Ediciones 2015-03-01
Series:Revista Espanola de Enfermedades Digestivas
Subjects:
Online Access:http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000300002&lng=en&tlng=en
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author Alfredo J. Lucendo
Tomás Sánchez-Casanueva
Olga Redondo
José M. Tenias
Ángel Arias
author_facet Alfredo J. Lucendo
Tomás Sánchez-Casanueva
Olga Redondo
José M. Tenias
Ángel Arias
author_sort Alfredo J. Lucendo
collection DOAJ
description Background and aim: Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. Methods: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI), were calculated. A fixed or random effects model was used depending on heterogeneity (I²). Publication bias risks were assessed by means of funnel plot analysis. Results: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment), met the inclusion criteria and were included in the quantitative summary. Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 %) of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 %) of patients not receiving antiplatelet therapy. Pooled relative risk (RR) for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I² = 0 %); pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I² = 0 %) and for dual antiplatelet therapy, 2.13; (95 % CI 0.77, 5.91; I² = 47 %). No significant publication bias was evident for the different medications analyzed. Conclusion: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.
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spelling doaj.art-0c2417bc99d24b6a91d39e994974b4772022-12-21T18:11:31ZengAran EdicionesRevista Espanola de Enfermedades Digestivas1130-01082015-03-011073128136S1130-01082015000300002Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysisAlfredo J. Lucendo0Tomás Sánchez-Casanueva1Olga Redondo2José M. Tenias3Ángel Arias4Hospital General de TomellosoHospital General de TomellosoComplejo Hospitalario La Mancha CentroEscola Valenciana d' Studis de la SalutComplejo Hospitalario La Mancha CentroBackground and aim: Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. Methods: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI), were calculated. A fixed or random effects model was used depending on heterogeneity (I²). Publication bias risks were assessed by means of funnel plot analysis. Results: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment), met the inclusion criteria and were included in the quantitative summary. Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 %) of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 %) of patients not receiving antiplatelet therapy. Pooled relative risk (RR) for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I² = 0 %); pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I² = 0 %) and for dual antiplatelet therapy, 2.13; (95 % CI 0.77, 5.91; I² = 47 %). No significant publication bias was evident for the different medications analyzed. Conclusion: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000300002&lng=en&tlng=enPEGGastrostomyTube feedingGastric feeding tubesAntiplatelet drugsAspirinClopidogrel
spellingShingle Alfredo J. Lucendo
Tomás Sánchez-Casanueva
Olga Redondo
José M. Tenias
Ángel Arias
Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
Revista Espanola de Enfermedades Digestivas
PEG
Gastrostomy
Tube feeding
Gastric feeding tubes
Antiplatelet drugs
Aspirin
Clopidogrel
title Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
title_full Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
title_fullStr Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
title_full_unstemmed Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
title_short Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis
title_sort risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy peg tube insertion under antiplatelet therapy a systematic review with a meta analysis
topic PEG
Gastrostomy
Tube feeding
Gastric feeding tubes
Antiplatelet drugs
Aspirin
Clopidogrel
url http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000300002&lng=en&tlng=en
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