Risk of late bleeding following hemorrhoidal banding in patients on antithrombotic prophylaxis

• Published in: The American journal of surgery Vol. 196; no. 6; pp. 994 - 999
• Main Authors: Nelson, R. Scott, D.O, Ewing, B. Mark, B.S, Ternent, Charles, M.D, Shashidharan, Maniamparampil, M.D, Blatchford, Garnet J., M.D, Thorson, Alan G., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2008; Elsevier Limited
• Subjects: Anticoagulants; Anticoagulation; Antiplatelet therapy; Banding; Bleeding; Drug therapy; Emergency medical care; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - prevention & control; Heart attacks; Hemorrhoids; Hemorrhoids - complications; Hemorrhoids - surgery; Humans; Incidence; Ligation - methods; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - prevention & control; Prognosis; Retrospective Studies; Risk Factors; Surgery; Thrombosis - complications; Thrombosis - prevention & control; United States - epidemiology; United States; Antiplatelet therapy; Anticoagulation; Banding; Hemorrhoids; Bleeding
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2008.07.036

Abstract Background The risk of bleeding following rubber band ligation of internal hemorrhoids is 1%–2%. This risk may be increased in patients taking antithrombotic therapy. The goal of the current study was to find a safer approach to banding without increasing the risk of bleeding. Methods This retrospective review identified patients undergoing banding while on antithrombotic therapy. These medications were held for 7–10 days following the procedure. The number of bands placed while on antithrombotic therapy and their post band complications were recorded. Results There were 605 bands placed on 364 patients taking antithrombotic medications. There were 23 complications involving bleeding, a value that was not statistically different from those not taking antithrombotic therapy. Patients on clopidogrel experienced 50% of the significant bleeding episodes and 18% of the insignificant bleeding episodes. Conclusions Holding antithrombotic medication following banding appears to equalize the risk of bleeding to that of patients not taking antithrombotic medications. Patients taking clopidogrel may be at higher risk for bleeding complications.