Bleeding Complications after Rubber Band Ligation of Internal Hemorrhoids in Anticoagulated Patients

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Surg


Introduction: Symptomatic internal hemorrhoids are a common colorectal disease that is often treated in clinic by rubber band ligation (RBL), with a bleeding complication rate around 1.8% of patients. There are sparse data evaluating hemorrhage after rubber band ligation in anticoagulated patients, except for a few case reports and series stating it is not recommended.

Methods: A retrospective review was conducted of all patients who underwent rubber band ligation in the office of the colorectal surgery department for internal hemorrhoids while on anticoagulation, from January 1, 2010 to August 30, 2020. The patients were evaluated for any postoperative issue within 30 days. A bleeding event was considered significant if the patient required hospital admission, blood transfusion, or additional procedures to stop bleeding.

Results: Sixteen patients were identified on anticoagulation (31% [n=5] apixaban, 50% [n=8] warfarin, 19% [n=3] Xarelto); they had 30 clinic visits with a total of 33 band ligations. The mean age of patients was 74.5 years (range 60-92 years), 62.5% were male (n=10), with a mean BMI of 32.4±6.6 kg/m2. There were 2 significant bleeding events (6.67%) while on warfarin and apixaban; both of these patients were admitted to the hospital (3 and 13 days post-procedure), and 1 received 2 blood transfusions. No patient required any surgical or endoscopic intervention.

Conclusion: While the risk of bleeding after RBL for hemorrhoids is slightly higher in fully anticoagulated patients, it was well tolerated by the majority. Our results support that RBL may be done in this high-risk population with close monitoring.





First Page