title: Anticoagulation management around percutaneous bedside procedures: is adjustment required?
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) and percutaneous dilatational tracheostomy (PDT) are frequently performed bedside in the intensive care unit. Critically ill patients frequently require anticoagulant (AC) and antiplatelet (AP) therapies for myriad indications. There are no societal guidelines proffering strategies to manage AC/AP therapies periprocedurally for bedside PEG or PDT. The aim of this study is to evaluate the management of AC/AP therapies around PEG/PDT, assess periprocedural bleeding complications, and identify risk factors associated with bleeding.
  
  
  METHODS
  A retrospective, observational study of all adult patients admitted from October 2004 to December 2009 receiving a bedside PEG or PDT was conducted. Patients were identified by procedure codes via an in-hospital database. A medical record review was performed for each included patient.
  
  
  RESULTS
  Four hundred fifteen patients were included, with 187 PEGs and 352 PDTs being performed. Prophylactic anticoagulation was held for approximately one dose before and two doses or less after the procedure. There was wide variation in patterns of holding therapy in patients receiving anticoagulation via continuous infusion. There were 19 recorded minor bleeding events, 1 (0.5%) with PEG and 18 (5.1%) with PDT, with no hemorrhagic events. No association was found between international normalized ratio, prothrombin time, or activated partial thromboplastin time values and bleed risk (p = 0.853, 0.689, and 0.440, respectively). Platelet count was significantly lower in patients with a bleeding event (p = 0.006).
  
  
  CONCLUSIONS
  We found that while practice patterns were quite consistent in regard to the management of prophylactic anticoagulation, it varied widely in patients receiving therapeutic anticoagulation. It seems that prophylactic anticoagulation use did not affect bleed risk with PEG/PDT.
authors.affiliation: Fletcher Allen Health Care, 111 Colchester Avenue, 272-BA1, Burlington, VT 05401, USA. cassie.barton@vtmednet.org
authors.forename: Cassie A
authors.initials: CA
authors.lastname: Barton
authors.forename: Wesley D
authors.initials: WD
authors.lastname: McMillian
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.forename: William E
authors.initials: WE
authors.lastname: Charash
authors.forename: Peter A
authors.initials: PA
authors.lastname: Igneri
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Brenny
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Aloi
authors.forename: John B
authors.initials: JB
authors.lastname: Fortune
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019095:Point-of-Care Systems; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*
chemical_list: D000925:Anticoagulants