03:27 PM Abstract No. 309 Safety and feasibility of percutaneous gastrostomy tube placement on patients receiving antiplatelet therapy after cerebral vascular accident

Dysphagia occurs in 50% of patients following a cerebrovascular accident (CVA), which can lead to aspiration and pulmonary complications. Gastrostomy tubes are often placed in the interventional radiology department to mitigate these complications. However, following a CVA, patients are routinely treated with antiplatelet therapy (APT) to prevent further thromboembolic events. This study aims to identify the safety and feasibility of performing gastrostomy tube placement in patients on APT. Retrospective analysis was performed on 154 consecutive patients following gastrostomy tube placement from August 2017 to August 2018. Demographics, procedure indication, APT regimen, and gastrostomy tube type (push vs pull) were compared with short-term outcomes. Complications were categorized based on SIR Clinical Practice Guidelines. CVA was the indication in 102 patients. Of the 154 gastrostomy tubes, 72 were performed while on APT (31 on dual antiplatelet therapy). Gastrostomy tube placement was successful in all patients. Of the 154 patients receiving gastrostomy tube placement, a total of 12 complications were observed (10 minor complications and 2 major complications). Bleeding-specific complications occurred in 6 patients (4 minor/2 major). The most common complication was minimal bleeding around the incision site (n=4). Both major bleeding complications occurred in patients not receiving APT. No difference in complication rate was noted based on indication (p=0.17), gastrostomy tube type (p=0.21), single APT (p=0.42), or DAPT (p=0.26). In the CVA cohort, no difference in complication rate was identified between gastrostomy tube type (p=0.29), ASA use (p=0.96), Plavix use (p=0.69), single APT (p=0.24), or DAPT (p=0.45). Of the 6 bleeding-specific complications, recent CVA was associated with increased risk (6% vs 0%, p=0.01). However, no difference in bleeding rate complications were present in patients on DAPT (6.5% vs 3.3%, p=0.44) or single APT (0% vs 5.3%, p=0.14). Antiplatelet therapy can be safely maintained in patients following recent CVA for gastrostomy tube placement without increased risk of bleeding.