title: Risk of late bleeding following hemorrhoidal banding in patients on antithrombotic prophylaxis.
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.
authors.affiliation: Colon and Rectal Surgery, Inc, Omaha, NE, USA. warmerinne@cox.net
authors.forename: R Scott
authors.initials: RS
authors.lastname: Nelson
authors.forename: B Mark
authors.initials: BM
authors.lastname: Ewing
authors.forename: Charles
authors.initials: C
authors.lastname: Ternent
authors.forename: Maniamparampil
authors.initials: M
authors.lastname: Shashidharan
authors.forename: Garnet J
authors.initials: GJ
authors.lastname: Blatchford
authors.forename: Alan G
authors.initials: AG
authors.lastname: Thorson
mesh_terms: D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008026:Ligation / Q000379:methods; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000150:complications / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents