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. 2023 May;68(5):1966-1974.
doi: 10.1007/s10620-022-07804-1. Epub 2023 Jan 31.

Dual Antiplatelet Therapy Does Not Increase Bleeding Risk in Percutaneous Gastrostomy Tube Placement: Network Meta-Analysis

Manesh Kumar Gangwani  1 , Muhammad Aziz  2 , Abeer Aziz  3 , Fnu Priyanka  4 , Arti Patel  5 , Umar Ghaffar  5 , Simcha Weissman  5 , Mahmood Asif  6 , Wade Lee-Smith  7 , Toseef Javaid  2 , Ali Nawras  2 , Benjamin Hart  2
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Dual Antiplatelet Therapy Does Not Increase Bleeding Risk in Percutaneous Gastrostomy Tube Placement: Network Meta-Analysis

Manesh Kumar Gangwani et al. Dig Dis Sci. 2023 May.

Abstract

Background/objective: Gastrostomy tube (G tube) is a commonly performed procedure for nutritional support. Current guidelines recommend discontinuation of dual antiplatelet therapy (DAPT) prior to G tube placement to reduce bleeding risk.

Aims: We aim to compare bleeding risk in single, dual and no antiplatelet therapy during G tube placement.

Methods: We searched PubMed, Embase, Cochrane, and Web of Sciences to include comparative studies evaluating single antiplatelet (aspirin, clopidogrel), dual antiplatelet (DAPT, aspirin and clopidogrel), and no antiplatelet therapy. Direct as well as network meta-analyses comparing these arms were performed. Risk Differences (RD) with confidence intervals were calculated.

Results: 12 studies with 8471 patients were included. On direct meta-analysis, there was no significant difference noted between DAPT compared to Aspirin (RD 0.001 95% CI - 0.012 to 0.014, p = 0.87), Clopidogrel (RD 0.001 95% CI - 0.009 to 0.010, p = 0.92) or no antiplatelet group (RD 0.007 95% CI - 0.011 to 0.026, p = 0.44). Results were consistent on network meta-analysis and no difference was noted in bleeding rates when comparing DAPT with Aspirin (RD 0.001, 95% CI - 0.007 to 0.01, p = 0.76), Clopidogrel (RD 0.001, 95% CI - 0.01 to 0.011, p = 0.90) and no antiplatelet group (RD 0.002, 95% CI - 0.007 to 0.012, p = 0.62).

Conclusion: There is no significant difference in bleeding risk between DAPT, single antiplatelet or no antiplatelet therapy on a population level. On an individual level, risk of ischemic events should be weighed against the risk of bleeding based on patient circumstances and risk profile. Our findings offer to provide additional data to make an informed decision between patients and physicians to make clinical decisions by assessing individual risks and benefits for optimal care of complex patients.

Keywords: Antiplatelet; Aspirin; Bleeding; Feeding tube; PEG; Plavix.

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References

    1. Molina Villalba C, Vázquez Rodríguez J, Gallardo Sánchez F. Gastrostomía endoscópica percutánea. Indicaciones, cuidados y complicaciones. Medicina Clínica 2019;152:229–236. - DOI - PubMed
    1. Lucendo A, Sánchez-Casanueva T, Redondo O, Tenías J, Arias Á. Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis. Revista Española de Enfermedades Digestivas 2015;107:128–136. - PubMed
    1. Page M, Moher D, Bossuyt P, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;n160.
    1. https://handbook-5-1.cochrane.org/chapter_9/9_4_3_a_generic_inverse_vari...
    1. Nisbet R, Elder J, Miner G. Data Understanding and Preparation. Handbook of Statistical Analysis and Data Mining Applications, 2009: 49–75.

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