title: Do we have to stop anticoagulant and platelet-inhibitor treatments during proctological surgery?
abstract: OBJECTIVE
  This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments.
  
  
  METHODS
  The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology.
  
  
  RESULTS
  A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) (P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin.
  
  
  CONCLUSIONS
  During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk.
authors.affiliation: Hôpital Bagatelle, Service de Proctologie, Talence, France. proctobagatelle@mspb.com
authors.forename: F
authors.initials: F
authors.lastname: Pigot
authors.forename: F
authors.initials: F
authors.lastname: Juguet
authors.forename: D
authors.initials: D
authors.lastname: Bouchard
authors.forename: A
authors.initials: A
authors.lastname: Castinel
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D005260:Female; D006484:Hemorrhoids / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin