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      Serotonin reuptake inhibitors and post-gastrostomy bleeding: reevaluating the link

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          Serotonin reuptake inhibitors (SRIs) are one of the most commonly prescribed classes of medications with a relatively safe side-effect profile. However, SRIs are being increasingly reported to be associated with bleeding complications in patients undergoing invasive procedures resulting from inhibition of serotonin reuptake by platelets and impaired platelet aggregation. The aim of our study was to determine whether there is an increased risk of post-percutaneous endoscopic gastrostomy (PEG) bleeding in patients exposed to SRIs after controlling for other mediations known to increase the risk of bleeding and major comorbidities.


          This was a single-center cohort study that included who underwent PEG tube placement by standard pull-guidewire technique from July 2006 to June 2014. Patients were categorized into groups based on the medications (SRIs, aspirin, non-steroidal anti-inflammatory drugs, and anticoagulants) administered during the index hospitalization. The incidence of post-PEG bleeding was noted in two distinct post-procedure periods: within 48 hours, and between 48 hours and 14 days.


          A total of 637 PEG tube placements were done on 570 patients during the study period. There were 107 patients (18.8%) with major bleeding within 48 hours of PEG and 79 patients (13.9%) with major bleeding between 48 hours and 14 days. There was no significant increase in the post-PEG bleeding in patients taking a combination of an SRI along with aspirin or non-steroidal anti-inflammatory drugs. Patients on subcutaneous heparin for prophylaxis against thromboembolic events were more likely to have oozing at the PEG site requiring blood transfusion.


          We did not notice an increase in post-PEG bleeding in patients on SRIs. However, in view of the limitation that our study is retrospective and that there are no known significant side effects of withdrawal of SRIs for a short duration, withholding SRIs could be a safe clinical option in patients undergoing PEG tube placement.

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          Most cited references 19

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          Management of antithrombotic agents for endoscopic procedures.

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            Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis.

            There is emerging concern that selective serotonin reuptake inhibitors (SSRIs) may be associated with an increased risk of upper gastrointestinal (GI) bleeding, and that this risk may be further increased by concurrent use of nonsteroidal anti-inflammatory (NSAID) medications. Previous reviews of a relatively small number of studies have reported a substantial risk of upper GI bleeding with SSRIs; however, more recent studies have produced variable results. The objective of this study was to obtain a more precise estimate of the risk of upper GI bleeding with SSRIs, with or without concurrent NSAID use.
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              Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures.

              This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of endoscopic procedures in conjunction with anticoagulation and/or antiplatelet therapy. Guidelines for the appropriate practice of endoscopy are based on critical review of the available data and expert consensus. Controlled clinical studies would be beneficial to clarify some aspects of this statement and revision might be necessary as new data appear. Clinical consideration may justify a course of action at variance from these specific recommendations.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                27 August 2015
                : 11
                : 1283-1289
                Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
                Author notes
                Correspondence: Vinaya Gaduputi, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite #10C, Bronx, NY 10457, USA Tel +1 718 960 1234, Email vgaduput@ 123456bronxleb.org
                © 2015 Patel et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research


                sri bleeding, peg bleeding, ssri bleeding, gastrostomy, peg, gastrostomy bleeding


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