SA102 - Do Anticoagulants Increase the Risk of Bleeding After Rubber Band Ligation for Internal Hemorrhoids?

Purpose/Background: Internal hemorrhoids are a prevalent condition which is often treated with rubber band ligation (RBL). Major bleeding complications after RBL are uncommon but well-recognized. Traditionally, anticoagulants (AC) have been regarded as a relative contraindication for RBL due to the risk of post-procedure hemorrhage. The impact and safety of AC on RBL, however, have been inadequately studied. In this study, we analyzed the risk of bleeding after RBL in patients on AC at our institution.

Methods/Interventions: Adult patients who underwent office-based RBL from June 2013 to May 2023 were identified using the Current Procedural Terminology (CPT) code 46221 in our institutional database. Demographics, grade of hemorrhoids, number of bands placed, periprocedural use of AC and antiplatelets, and post-procedure hemorrhage within 30 days of the procedure were compared between patients on AC (AC group) and not on AC (non-AC group). Post-procedure hemorrhage was defined as those requiring a blood transfusion, experiencing a decrease in hemoglobin by 2g/dl or more, undergoing a procedure to control bleeding, or hospital admission due to the bleeding from the hemorrhoids.

Results/Outcomes: A total of 642 patients underwent 1,123 rubber band ligation procedures. The average patient age was 59.1, with 43.7% being female. Sixty-four procedures (5.7%) were performed for patients taking AC, and 243 procedures (21.6%) were done for those using antiplatelets. The majority of patients had grade 2 or 3 hemorrhoids, and had a single band applied during the procedure. When comparing the AC group to the non-AC group, patients in the AC group were older. There was no statistical difference in gender, grade of the hemorrhoids, number of bands applied during the procedure, and the use of antiplatelets between the two groups. In the AC group, 53 patients (83.8%) continued the medication before and after the procedure without any interruptions. The remaining patients were instructed to hold medications for 3-7 days prior to and/or up to 15 days after the procedure.

A total of 12 patients (1.1%) experienced post-procedure bleeding. Of these, 3 (4.7%) were in the AC group and 9 (0.8%) were in the non-AC group. Among the patients with post-procedure bleeding in the AC group, two continued AC periprocedural, while one held AC post-procedure. One patient in the AC group required a blood transfusion, and no procedures were needed to control the bleeding. The rate of bleeding was significantly higher in the AC group (p=0.027).

Conclusion/Discussion: This is one of the largest retrospective studies evaluating the safety of AC on RBL. While the rate of bleeding complications was higher in the AC group, the number of patients experiencing complications was small, with only one requiring a blood transfusion. Patients who require AC for their medical conditions can still undergo RBL safely.