Esophagus to Small Intestine

Dig Dis Sci. 2023;68(5):1966−74

Gangwani MK, Aziz M, Aziz A, Priyanka F, Patel A, Ghaffar U, Weissman S, Asif M, Lee-Smith W, Javaid T, Nawras A, Hart B

Dual antiplatelet therapy does not increase bleeding risk in percutaneous gastrostomy tube placement: Network meta-analysis

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: The study aims to compare bleeding risk in single, dual and no antiplatelet therapy during G tube placement.
Methods: The authors 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 com-paring these arms were performed. Risk differences (RD) with confidence intervals (CIs) 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: -0.012−0.014; p = 0.87), clopidogrel (RD, 0.001, 95% CI: -0.009−0.010; p = 0.92) or no antiplatelet group (RD, 0.007, 95% CI: -0.011−0.026; 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: -0.007−0.01; p = 0.76), clopidogrel (RD, 0.001, 95% CI: -0.01−0.011; p = 0.90) and no an-tiplatelet group (RD, 0.002, 95% CI: -0.007−0.012; p = 0.62).

Conclusion: There is no significant difference in bleeding risk between dual antiplatelet therapy, 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. The 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.

M.K. Gangwani, M.D., Assistant Professor, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA,
E-Mail: maneshku-mar.gangwani@utoledo.edu

DOI: 10.1007/s10620-022-07804-1

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this could be of interest:

Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy

Am J Gastroenterol. 2023;118(4):627−34

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

Gut. 2023;72:1054−72

Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Cas-tro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Brglez Jurecic N, Den-kovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O’Morain C, Gisbert JP; Hp-EuReg Investigators