Risk of bleeding following hemorrhoidal banding in patients on antithrombotic therapy Risque de saignement après ligature élastique pour hémorroïdes chez des patients traités par anticoagulants ou antiagrégants plaquettaires

Hemorrhoidal banding is an office procedure for the treatment of grade 1 to 3 internal hemorrhoids. It has been shown to be a safe and relatively effective way to treat minimally symptomatic hemorrhoids without a formal operation. Risks associated with hemorrhoidal banding have been well described and range from bleeding, urinary retention, recurrence and, rarely, sepsis or death. The overall risk of complications following placement of a hemorrhoidal band ranges from 3.5 to 10% [1—6]. Bleeding is the most common complication associated with hemorrhoidal banding, with minor or insignificant bleeding being reported in as many as 1.7% and major or significant bleeding in 0.8% of patients [1—5]. Recommendations for patients who are candidates for rubber band ligation but are on antithrombotic therapy have never been formally evaluated. Some studies have shown subsets of patients with a much higher bleed rate, ranging from 7 to 25% [1,2,7], while on antithrombotic medication. Many authors recommend not banding any patient until they have been off their medication for 7—10 days before the banding, followed by a further 7—10 days thereafter [8—10]. This treatment algorithm leads to multiple office visits for diagnosis and subsequent treatment and an increased time off their medication which may lead to a greater risk of stroke, myocardial infarction, or deep venous thrombosis [11—15]. Prophylaxis against heart disease and stroke, treatment for deep venous thrombosis and the recent placement of cardiac stents are the most common reasons why patients require some form of anticoagulant or antiplatelet therapy. Patients taking aspirin for coronary artery disease have been reported to have a new coronary event 4.1% of the time when stopping their aspirin [14]. The risk of stroke in c r u p s