Does Aspirin Increase the Risk of Bleeding for Percutaneous Endoscopic Gastrostomy Procedure?

Abstract

Background: Bleeding is a potential complication following the placement of a percutaneous endoscopic gastrostomy (PEG) tube. Aspirin is commonly used for associated co morbid condition in patients requiring PEG placement. Although aspirin is commonly withdrawn before the procedure, the risk of bleeding on continuing aspirin is not known. Aim: The aim of the study was to determine the risk of bleeding for PEG tube placement in patients with aspirin. Methods: The records of 312 consecutive patients who had PEG procedure as inpatient were reviewed. The incidence of bleeding was noted in patients who remained on aspirin or received aspirin within 5 days before the procedure (group A) and compared with patients who did not receive aspirin or in whom aspirin was stopped more than 7 days before the procedure (group B). The presence of coagulopathy, thrombocytopenia and other antiplatelet agent, including clopidogrel, was recorded in all patients. The primary outcome was overt bleeding within 48 hrs, and secondary outcomes were drop of hemoglobin by 2 gm, any requirement of blood transfusion, or intervention including endoscoscpy, during the hospital stay. Fisher's exact test was used to calculate the difference between two groups. Results: 106 (34.4%) patients were included in group A (Age 27-98 yrs, median 79 yrs), and 202 (65.6%) were in group B (Age 22-100 yrs, median 78 yrs); 4 patients were excluded due to discharge within 48 hrs of the procedure. Bleeding was seen in 10 (3.2%) patients; 7 (6.6%) in group A (all received aspirin within 48 hrs before the procedure), and 3 (1.5%) in group B. The difference was not statistically significant (p = 0.1). Among patients with bleeding, 2 patients in group A and one patient in group B were on coumadin (INR 1.8-2.2) at the time of procedure. In addition, 2 patients in group A were on clopidogrel that was not stopped. One patient in group A had hematoma at the PEG tube site. All patients were managed with stopping the respective drug/s, blood transfusion (required in 7 patients, 1-3 units of PRBC), and one patient in group B required left gastric artery embolization. None of patients in either group died due to bleeding related complications. Conclusions: Use of aspirin does not increase the risk of bleeding in patients undergoing PEG procedure. The post-procedure bleeding does not lead to increase in mortality. Concomitant use of coumadin or anti-platelet agents may increase the risk of bleeding, but it needs confirmation with studies with a larger sample size.