Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis.

BACKGROUND AND AIM: Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. METHODS: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI), were calculated. A fixed or random effects model was used depending on heterogeneity (I2). Publication bias risks were assessed by means of funnel plot analysis. RESULTS: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment), met the inclusion criteria and were included in the quantitative summary.Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 %) of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 %) of patients not receiving antiplatelet therapy. Pooled relative risk (RR) for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I2 = 0 %); pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I2 = 0 %) and for dual antiplatelet therapy, 2.13; (95 % CI 0.77,5.91; I2 = 47 %). No significant publication bias was evident for the different medications analyzed. CONCLUSION: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.

Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis / Riesgo de sangrado en pacientes sometidos a inserción de un tubo de gastrostomía percutánea endoscópica y en tratamiento antiplaquetario: una revisión sistemática con metaanálisis

BACKGROUND AND AIM: Patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. METHODS: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI), were calculated. A fixed or random effects model was used depending on heterogeneity (I2). Publication bias risks were assessed by means of funnel plot analysis. RESULTS: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment), met the inclusion criteria and were included in the quantitative summary. Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 %) of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 %) of patients not receiving antiplatelet therapy. Pooled relative risk (RR) for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I 2 = 0 %); pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I 2 = 0 %) and for dual antiplatelet therapy, 2.13; (95 % CI 0.77, 5.91; I2 = 47 %). No significant publication bias was evident for the different medications analyzed. CONCLUSION: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study

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Efectos de un programa de Atención Farmacéutica para pacientes con esclerosis múltiple sobre la adherencia al tratamiento inmunomodulador / Effects of a pharmaceutical care program for patients with multiple sclerosis on immunomodulatory treatment adherence

Objetivos: Analizar el efecto de la implantación de un programa de atención farmacéutica específico para pacientes con esclerosis múltiple sobre la adherencia al tratamiento inmunomodulador. Conocer con que fármacos han sido tratados, su duración, los tipos de tratamiento de inicio así como la frecuencia y sus motivos de cambio. Material y métodos: Programa de atención farmacéutica con un diseño pre-post exposición, longitudinal, prospectivo del 1 de junio a 31 de diciembre de 2011 sobre pacientes con esclerosis múltiple, en tratamiento con algún fármaco inmunomodulador parenterales dispensados de forma ambulatoria. Retrospectivamente también se recogieron y analizaron variables relacionadas con los tratamientos inmunomoduladores recibidos y con la adherencia: % de adherencia = (dosis de fármaco dispensadas/ dosis necesarias) x 100. Se utilizó como nivel de significación una p<0,05 y un intervalo de confianza del 95%.Resultados: La adherencia previa (97,3%) fue inferior a la obtenida durante el periodo de estudio (98,4%): -1,12 (IC 95%= -3,39 - 1,14; p= 0,326). El tratamiento más frecuentemente administrado e iniciado fue el interferón-β. La duración mediana de los tratamientos fue de 39,5 meses (6,5 - 172). El principal motivo de cambio fue la respuesta subóptima. Conclusiones: La adherencia fue siempre muy elevada y superior durante la fase prospectiva, pero no de manera significativa. Se observó un predominio de las terapias con interferón-β probablemente debido a ser el primer fármaco inmunomodulador disponible. El principal motivo de cambio observado fue la respuesta subóptima. Debido a su efectividad a largo plazo, los tratamientos inmunomoduladores se han mantenido durante largos periodos de tiempo

Aim: Analyze the effect of the implementation of a pharmaceutical care program specific for patients with multiple sclerosis on immunomodulatory treatment adherence. To know the drugs with which the patients have been treated, the duration, the types of treatment initiation, the frequency of change and its reasons. Methods: A prospective, longitudinal study with a pre/post exposure design regarding the pharmaceutical care program implemented. All multiple sclerosis patients treated with immunomodulatory drugs from June 1 to December 31, 2011, were included. Also retrospectively were collected and analyzed variables related to immunomodulatory treatments received and adherence: % adherence = (dispensed drug dose / dose necessary) x 100. Was used as a significance level of p <0.05 and a confidence interval of 95%. Results: Prior adherence (97.3%) was lower than that obtained during the study period (98.4%): -1.12 (95% CI = -3.39 a 1.14, P = 0.326). The most common treatment administered and initiated was the interferon-alfa. The median duration of treatment was 39.5 months (6.5 - 172). The main reason of change was the suboptimal response. Conclusion: Adherence was always very high and higher during the prospective phase, but not significantly. There was a predominance of therapies with interferon-alfa, probably due it was the first immunomodulatory drug available. The main reason of change observed was the suboptimal response. Because of its long-term effectiveness, immunomodulatory therapies have been maintained for long periods

Efectos de un programa de Atención Farmacéutica para pacientes con esclerosis múltiple sobre la adherencia al tratamiento inmunomodulador / Effects of a pharmaceutical care program for patients with multiple sclerosis on immunomodulatory treatment adherence

Objetivos: Analizar el efecto de la implantación de un programa de atención farmacéutica específico para pacientes con esclerosis múltiple sobre la adherencia al tratamiento inmunomodulador. Conocer con que fármacos han sido tratados, su duración, los tipos de tratamiento de inicio así como la frecuencia y sus motivos de cambio. Métodos: Programa de atención farmacéutica con un diseño pre-post exposición, longitudinal, prospectivo del 1 de junio a 31 de diciembre de 2011 sobre pacientes con esclerosis múltiple, en tratamiento con algún fármaco inmunomodulador parenterales dispensados de forma ambulatoria. Retrospectivamente también se recogieron y analizaron variables relacionadas con los tratamientos inmunomoduladores recibidos y con la adherencia: % de adherencia= (dosis de fármaco dispensadas/ dosis necesarias) x 100. Se utilizó como nivel de significación una p<0,05 y un intervalo de confianza del 95%. Resultados: La adherencia previa (97,3%) fue inferior a la obtenida durante el periodo de estudio (98,4%): -1,12 (IC 95%= -3,39 - 1,14; p= 0,326). El tratamiento más frecuentemente administrado e iniciado fue el interferón-β. La duración mediana de los tratamientos fue de 39,5 meses (6,5 - 172). El principal motivo de cambio fue la respuesta subóptima. Conclusiones: La adherencia fue siempre muy elevada y superior durante la fase prospectiva, pero no de manera significativa. Se observó un predominio de las terapias con interferón-β probablemente debido a ser el primer fármaco inmunomodulador disponible. El principal motivo de cambio observado fue la respuesta subóptima. Debido a su efectividad a largo plazo, los tratamientos inmunomoduladores se han mantenido durante largos periodos de tiempo (AU)

Aim: Analyze the effect of the implementation of a pharmaceutical care program specific for patients with multiple sclerosis on immunomodulatory treatment adherence. To know the drugs with which the patients have been treated, the duration, the types of treatment initiation, the frequency of change and its reasons. Methods: A prospective, longitudinal study with a pre/post exposure design regarding the pharmaceutical care program implemented. All multiple sclerosis patients treated with immunomodulatory drugs from June 1 to December 31, 2011, were included. Also retrospectively were collected and analyzed variables related to immunomodulatory treatments received and adherence: % adherence = (dispensed drug dose / dose necessary) x 100. Was used as a significance level of p <0.05 and a confidence interval of 95%. Results: Prior adherence (97.3%) was lower than that obtained during the study period (98.4%): -1.12 (95% CI = -3.39 a 1.14, P = 0.326). The most common treatment administered and initiated was the interferon-β. The median duration of treatment was 39.5 months (6.5 - 172). The main reason of change was the suboptimal response. Conclusions: Adherence was always very high and higher during the prospective phase, but not significantly. There was a predominance of therapies with interferon- β, probably due it was the first immunomodulatory drug available. The main reason of change observed was the suboptimal response. Because of its long-term effectiveness, immunomodulatory therapies have been maintained for long periods (AU)