Lucendo Alfredo J, Sánchez-Casanueva Tomás, Redondo Olga, Tenías José M, Arias Ángel
Rev Esp Enferm Dig. 2015 Mar;107(3):128-36.
Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement.
A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI), were calculated. A fixed or random effects model was used depending on heterogeneity (I2). Publication bias risks were assessed by means of funnel plot analysis.
Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment), met the inclusion criteria and were included in the quantitative summary.Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 %) of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 %) of patients not receiving antiplatelet therapy. Pooled relative risk (RR) for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I2 = 0 %); pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I2 = 0 %) and for dual antiplatelet therapy, 2.13; (95 % CI 0.77,5.91; I2 = 47 %). No significant publication bias was evident for the different medications analyzed.
Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.
接受经皮内镜下胃造口术（PEG）置管的患者通常正在接受抗血小板治疗，如果停用这些药物则存在潜在的血栓栓塞风险。本系统评价旨在评估维持阿司匹林和/或氯吡格雷治疗是否会增加PEG置管后出血的风险。
针对调查接受抗血小板治疗的患者在进行PEG管插入时出血风险的研究，对MEDLINE、EMBASE和SCOPUS数据库进行了系统检索。计算了汇总估计值，包括95%置信区间（CI）。根据异质性（I²）使用固定效应或随机效应模型。通过漏斗图分析评估发表偏倚风险。
11项研究共纳入6233例患者（其中3665例正在接受抗血小板治疗），符合纳入标准并纳入定量汇总分析。在全部人群中，2.67%（95%CI 1.66%，3.91%）出现了任何与PEG管置管相关的出血，在未接受抗血小板治疗的患者中这一比例为2.7%（95%CI 1.5%，4.1%）。与对照组相比，服用阿司匹林的患者出血的合并相对风险（RR）为1.43（95%CI 0.89，2.29；I² = 0%）；氯吡格雷的合并RR为1.21（95%CI 0.48，3.04；I² = 0%），双联抗血小板治疗的合并RR为2.13（95%CI 0.77，5.91；I² = 47%）。对所分析的不同药物而言，均未发现明显的发表偏倚。
抗血小板治疗在接受PEG管插入的患者中是安全的。需要未来进行更大样本量的前瞻性随机研究来证实本研究结果。
