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

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An Invited Commentary to this article was published on 17 March 2023

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.

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Abbreviations

G tube:

Gastrostomy tube (endoscopically or radiologically)

PEG:

Percutaneous endoscopic gastrostomy

DAPT:

Dual antiplatelet therapy

GI:

Gasto-intestinal

SAPT:

Single antiplatelet therapy

RD:

Risk difference

RIG:

Radiologically inserted G tube

NACE:

Net adverse clinical events

MACE:

Major adverse cardiovascular events

CVA:

Cerebrovascular accident

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Funding

No funding was received for the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA

    Manesh Kumar Gangwani & Mahmood Asif

  2. Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA

    Muhammad Aziz, Toseef Javaid, Ali Nawras & Benjamin Hart

  3. Division of Medicine, Aga Khan University, Karachi, Pakistan

    Abeer Aziz

  4. Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan

    Fnu Priyanka

  5. Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA

    Arti Patel, Umar Ghaffar & Simcha Weissman

  6. University of Toledo Libraries, University of Toledo, Toledo, OH, 43614, USA

    Wade Lee-Smith

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  1. Manesh Kumar Gangwani
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Correspondence to Manesh Kumar Gangwani.

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An editorial commenting on this article is available at https://doi.org/10.1007/s10620-023-07878-5.

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Gangwani, M.K., Aziz, M., Aziz, A. et al. Dual Antiplatelet Therapy Does Not Increase Bleeding Risk in Percutaneous Gastrostomy Tube Placement: Network Meta-Analysis. Dig Dis Sci 68, 1966–1974 (2023). https://doi.org/10.1007/s10620-022-07804-1

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