Effect of discontinuing antithrombotic drugs in patients undergoing percutaneous endoscopic gastrostomy

Abstract

The association between antithrombotic drugs and hemorrhagic complications was investigated in 201 patients who underwent percutaneous endoscopic gastrostomy (PEG) using the introducer technique between 2014 and 2017. Antithrombotic drugs were administered with preoperative withdrawal according to guidelines in 67 patients (antithrombotic group), but not in 134 patients (non-antithrombotic group). Antithrombotic drugs used (single-agent or multiagent therapy) were direct oral anticoagulants (24 patients), warfarin (12) and antiplatelets (34). Early complications occurred by postoperative day (POD) 14 in 33 patients. Hemorrhagic complications occurred in 7 patients in the antithrombotic group (10.5%) and 6 patients in the non-antithrombotic group (4.5%). Of 13 cases of hemorrhagic complications, 1 required endoscopic hemostasis the day after surgery, despite intraoperative clipping of a mucosal laceration; 11 cases had external bleeding from the insertion site, which was treated by site closure or pulling the tube with gauze. No patient required blood transfusion. Thromboembolism did not occur during antiplatelet withdrawal. PEG can be performed relatively safely with antithrombotic withdrawal with caution because of the moderate risk of hemorrhagic complications.