Anticoagulation management around percutaneous bedside procedures: is adjustment required?

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Pulmonology

Background:

• Percutaneous endoscopic gastrostomy (PEG) and percutaneous dilatational tracheostomy (PDT) are common bedside procedures in intensive care units.
• Critically ill patients often require anticoagulant (AC) and antiplatelet (AP) therapies.
• No established guidelines exist for managing AC/AP therapies during bedside PEG or PDT.

Purpose of the Study:

• To evaluate the management of AC/AP therapies around PEG/PDT procedures.
• To assess periprocedural bleeding complications.
• To identify risk factors associated with bleeding.

Main Methods:

• Retrospective, observational study of adult patients undergoing bedside PEG or PDT from October 2004 to December 2009.
• Patient identification via in-hospital database procedure codes.
• Comprehensive medical record review for included patients.

Main Results:

• 19 minor bleeding events occurred (1 with PEG, 18 with PDT); no hemorrhagic events.
• Prophylactic anticoagulation was typically held for one dose before and two doses or less after the procedure.
• Lower platelet count was associated with bleeding events (p=0.006); coagulation test values showed no association with bleed risk.

Conclusions:

• Practice patterns for prophylactic anticoagulation were consistent, but varied for therapeutic anticoagulation.
• Prophylactic AC/AP use did not demonstrate an association with increased bleed risk for PEG/PDT procedures.
• Further research may be needed to optimize AC/AP management in this patient population.