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

Risk of Bleeding After Percutaneous Endoscopic Gastrostomy (PEG)

“…Overall, the incidence of post-PEG bleeding in this study (3.3%) was very close to that previously reported in the literature (2.5-2.8%) [6,17,18]. Bleeding directly attributed to PEG placement (excluding unrelated peptic ulcer disease and other lesions) was very low (0.3%).…”

“…Furthermore, premature discontinuation of aspirin and clopidogrel in the setting of a drug-eluting coronary stent is associated with high incidence of stent thrombosis [37]. There is sufficient evidence to show that there is no statistically significant association of aspirin and bleeding after PEG [18] and after colonoscopy with polypectomy [3,38,39]. Data on clopidogrel in high-risk endoscopic procedures is more limited, but three studies [18,40,41] have demonstrated that clopidogrel alone was not an independent risk factor for post PEG and postpolypectomy bleeding.…”

“…Before the introduction of antiplatelet drugs, for example clopidogrel, the incidence of GI bleeding after PEG placement was approximately 2.5% [6,17]. A recent report [18] suggests that the incidence of post-PEG bleeding continues to be similar, approximately 2.8%.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…192 Continued administration of aspirin for PEG placement has not been associated with an increased risk of haemorrhage. 193 Additionally, there was no increased risk of haemorhage on clopidogrel in a retrospective single-centre casecontrol study of 990 patients, 194 although this study was statistically underpowered to demonstrate an effect due to this drug. There have been no studies examining the risk of PEG placement in patients on prasugrel, ticagrelor or DOAC.…”

Current Practices in the Management of Antithrombotic Therapy During the Periendoscopic Period for Patients With Cardiovascular Disease

“…Anticoagulants are categorized as either warfarins or novel oral anticoagulants (NOACs; eg, dabigatran, apixaban, rivaroxaban, or edoxaban); the former are indirect inhibitors, whereas the latter are direct inhibitors of the coagulation system. 31) Because of the difference in the mechanisms of action, patients receiving warfarin require longer time for the recovery of the coagulation system compared with those receiving NOACs. Therefore, transient heparinization (heparin bridge) has become a common practice for patients receiving warfarin.…”