Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 25, 2016; 8(16): 553-557
Published online Aug 25, 2016. doi: 10.4253/wjge.v8.i16.553
Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy
Umair Sohail, Chela Harleen, Amin O Mahdi, Murtaza Arif, Douglas L Nguyen, Matthew L Bechtold
Umair Sohail, Chela Harleen, Amin O Mahdi, Murtaza Arif, Matthew L Bechtold, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
Douglas L Nguyen, Department of Medicine, University of California, Irvine, CA 92697, United States
Author contributions: Sohail U, Arif M and Bechtold ML contributed to conception and design; Sohail U, Harleen C and Mahdi AO contributed to acquisition of data and drafting of manuscript; Sohail U, Arif M, Nguyen DL and Bechtold ML contributed to analysis and interpretation of data; Arif M, Nguyen DL and Bechtold ML contributed to critical revision of manuscript; Nguyen DL and Bechtold ML contributed to statistical expertise; Bechtold ML contributed to overall supervision of project.
Institutional review board statement: IRB reviewed and approved this project as a record review.
Informed consent statement: Given the nature of the retrospective record review, no informed consent was mandated per IRB.
Conflict-of-interest statement: No conflicts of interest noted.
Data sharing statement: Dataset is available from the corresponding author, Matthew Bechtold at bechtoldm@health.missouri.edu. Given that is a retrospective study, informed consent was not obtained for data sharing but data was anonymized and project approved by the IRB.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Matthew L Bechtold, MD, FACP, FASGE, FACG, AGAF, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, CE405, DC043.00, Five Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Telephone: +1-573-8821013 Fax: +1-573-8844595
Received: April 28, 2016
Peer-review started: April 29, 2016
First decision: May 17, 2016
Revised: June 1, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: August 25, 2016
Processing time: 117 Days and 12.8 Hours
Abstract
AIM

To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy (PEG) with or without clopidogrel.

METHODS

After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG (1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG.

RESULTS

Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirty-three patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesis within 48 h of percutaneous endoscopic gastrostomy (PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dL (2 vs 5 patients; P = 0.16), blood transfusions (2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding (no patients in either group).

CONCLUSION

Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.

Keywords: Percutaneous endoscopic gastrostomy; Clopidogrel; Bleeding; Complications; Antiplatelets

Core tip: Percutaneous endoscopic gastrostomy (PEG) is a common but invasive procedure. In the past, many medications were held prior to the procedure to reduce the risk of potential bleeding complication, such as clopidogrel. Much debate has been performed regarding the need for cessation of clopidogrel prior to PEG placement with little evidence found in the literature. This manuscript showed that clopidogrel use in patients undergoing PEG placement had no increased early post-procedure bleeding risk.