RISK OF BLEEDING AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY N PATIENTS ON DUAL ANTIPLATELET THERAPY: A POPULATION-BASED PROPENSITY-MATCHED STUDY

Introduction: Percutaneous endoscopic gastrostomy tube (PEG) placement is a common gastroenterological procedure that enables individuals with swallowing difficulties to receive nutritional support. Recent observational studies have indicated that there is no significant increase in bleeding risk following PEG placement in patients on dual antiplatelet therapy (DAPT). However, no population-based studies have previously assessed the safety of PEG in patients on DAPT.

Aim/Methods: This study aimed to assess the safety of PEG placement in patients on DAPT in comparison to those on aspirin or without any antiplatelet therapy. Utilizing the TrinNetX US collaborative network—a multi-institutional database covering over 100 million patients—Individuals who underwent PEG placement were identified and divided into three study groups based on the status of receiving antiplatelet therapy within 48 hours of the procedure (DAPT group, aspirin (ASA) group, no antiplatelet group). The primary outcome was gastrostomy-related bleeding within 30 days, with secondary outcomes encompassing mortality, ICU admission, the necessity for blood transfusion, and interventional radiology (IR) embolization during the same period.

Results: Our study included XX patients; 1,447 in the DAPT group, 12,898 in the ASA group, and 77,730 in the control (no anti-platelets) group. The mean age ± standard deviation was 67 ± 13, 66.3 ± 14.77, and 60.3 ± 18.4 years, respectively. Demographics, including gender, race, ethnicity, and comorbidities in the three groups, are detailed in Table 1. Using propensity score matching, the three groups were matched for age, sex, comorbidities, and anticoagulant use (Table 1). After matching, the risk of PEG-related bleeding within 30 days was 1.18% in the DAPT group, 1.38% in the aspirin group, and 0.69% in the control group (P value 0.62 for DAPT vs. aspirin, and 0.18 for DAPT vs. none) (Table 2). Overall mortality rates were 10.58%, 10.93%, and 12.93% in the DAPT, aspirin, and control groups, respectively. The need for blood transfusion was 4.01%, 3.87%, and 3.53% in the DAPT, aspirin, and control groups, respectively (Table 2).

Conclusion: This population-based study demonstrated no statistically significant increase in gastrostomy-related bleeding rates among patients on DAPT, aspirin therapy, or those not on any antiplatelets. These findings support the growing literature on the potential safety of this procedure in patients who need to continue receiving antiplatelets therapy.