Our Summary

The researchers in this study examined the link between the timing of post-surgery blood thinning medication (anticoagulants) and delayed bleeding after a hemorrhoidectomy (a surgery to remove hemorrhoids). The study looked back at all patients who underwent this procedure at a single hospital over a 10-year period.

The results showed that around 15% of these patients were taking a type of medication that stops blood platelets from clumping together (platelet inhibitors), and around 4% were taking other types of blood thinners. Delayed bleeding after surgery occurred in just over 5% of cases, and nearly half of those cases required another surgery to stop the bleeding.

Interestingly, the time it took for bleeding to occur was longer in those taking antiplatelet inhibitors compared to those taking other blood thinners or none at all. Among the patients who were taking blood thinners, more were taking a newer type of oral blood thinner than warfarin, a traditional blood thinner.

The study found that if these newer blood thinners were restarted more than three days after surgery, there was an increased risk of bleeding. However, the study also found that waiting longer to restart these drugs within the first week after surgery did not decrease the risk of bleeding.

The research concluded that patients on blood thinners are more likely to experience bleeding after a hemorrhoidectomy. Other factors that were found to increase the risk of delayed bleeding included being male and a certain type of stitch technique (operative oversewing) used during surgery.

FAQs

  1. What is the relationship between post-operative anticoagulation timing and delayed bleeding after a hemorrhoidectomy?
  2. How does the use of anticoagulants affect the frequency and timing of post-hemorrhoidectomy bleeding?
  3. Is there a difference in the occurrence of delayed bleeding in patients taking novel oral anticoagulants compared to those taking warfarin after a hemorrhoidectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hemorrhoidectomy is to discuss with their healthcare provider about the timing of restarting anticoagulants after surgery. Delayed bleeding is more likely to occur in patients on anticoagulation, and restarting anticoagulants later than 3 days after surgery may increase the risk of bleeding. It is important to follow the guidance of healthcare providers and discuss any concerns or questions about medication management post-surgery.

Suitable For

Patients who are typically recommended for hemorrhoidectomy are those who have severe or recurrent hemorrhoids that do not respond to conservative treatments such as dietary changes, fiber supplements, and topical medications. Additionally, patients who have large external hemorrhoids that are causing significant pain, bleeding, or discomfort may also be recommended for hemorrhoidectomy. It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine if hemorrhoidectomy is the best course of action for their specific situation.

Timeline

Before hemorrhoidectomy:

  • Patient may have symptoms of hemorrhoids such as bleeding during bowel movements, itching, and discomfort.
  • Consultation with a healthcare provider to discuss treatment options, including hemorrhoidectomy.
  • Pre-operative evaluation and preparation, which may include stopping certain medications such as anticoagulants.

After hemorrhoidectomy:

  • Recovery period, which may involve pain and discomfort for a few days.
  • Post-operative follow-up appointments with the healthcare provider to monitor healing and address any concerns.
  • Potential complications such as post-hemorrhoidectomy bleeding, which may occur within the first few weeks after surgery.
  • Treatment for delayed bleeding, which may include operative intervention if necessary.
  • Resumption of normal activities once healing is complete.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hemorrhoidectomy surgery?
  2. Should I stop taking any medications, such as anticoagulants, before the surgery?
  3. How soon after the surgery can I resume taking my anticoagulant medication?
  4. Are there any specific instructions or precautions I should follow regarding anticoagulant use post-surgery to minimize the risk of bleeding?
  5. How will you monitor me for potential post-operative bleeding, and what should I do if I experience any bleeding?
  6. Are there any signs or symptoms of post-hemorrhoidectomy bleeding that I should be aware of?
  7. What is the typical recovery process after a hemorrhoidectomy, and how long does it usually take to fully recover?
  8. Are there any lifestyle changes or preventive measures I can take to reduce the risk of hemorrhoids in the future?

Reference

Authors: Kolbeinsson HM, Otto M, Kogelschatz B, Virk U, Luchtefeld MA, Ogilvie JW Jr. Journal: Am Surg. 2023 Nov;89(11):4681-4688. doi: 10.1177/00031348221129512. Epub 2022 Sep 25. PMID: 36154315