The University of Toledo Translation Journal of Medical Sciences 
Hospital Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Bleeding Risk with Dual Antiplatelet Therapy and 
Gastrostomy Tube Placement: A Systematic Review and 
Network Meta-Analysis 

Manesh Kumar Gangwani, MD1*, Muhammad Aziz, MD2, Abeer Aziz, MD1, Fnu 
Priyanka, MD1, Arti Patel, MD1, Umar Ghaffar, MD1, Simcha Weissman, MD1, Asif 
Mahmood, MD1, Wade Lee-Smith, MLS3, Toseef Javaid, MD1, Ali Nawras, MD2 
Benjamin Hart, MD1 

1Division of Hospital Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
3Department of University Libraries, The University of Toledo, Toledo, OH 43614 

*Corresponding author: manesh.gangwani@utoledo.edu

Published: 05 May 2023 

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. We aim to compare bleeding risk in single, dual and no 
antiplatelet therapy during G tube placement.  

Methods: The following databases were 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 comparing 
these arms were performed using random effects model. Risk Differences (RD) with confidence 
intervals were calculated. 

Results: A total of 12 studies with 8471 patients were included in the final analysis. 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). These 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 
antiplatelet group (RD 0.002,95% CI -0.007–0.012, p = 0.62).  

https://dx.doi.org/10.46570/utjms.vol11-2023-744 

https://dx.doi.org/10.46570/utjms.vol11-2023-744
mailto:manesh.gangwani@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-744 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-744 2 ©2023 UTJMS 

Conclusion: There is no significant difference in bleeding risk between DAPT, single antiplatelet or no 
antiplatelet therapy. G tube placement can be safely performed while being on DAPT with no additional 
bleeding risk. 

https://dx.doi.org/10.46570/utjms.vol11-2023-744
https://dx.doi.org/10.46570/utjms.vol11-2023-744