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

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

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aspirin / adverse effects
  • Clopidogrel
  • Cohort Studies
  • Female
  • Gastrointestinal Hemorrhage / chemically induced*
  • Gastrointestinal Hemorrhage / etiology
  • Gastroscopy
  • Gastrostomy / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Serotonin Uptake Inhibitors / adverse effects*
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives
  • Time Factors
  • Young Adult

Substances

  • Serotonin Uptake Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin