Effect of Antithrombotic Therapy on Secondary Bleeding After Proctological Surgery

Maemoto, Ryo; Tsujinaka, Shingo; Miyakura, Yasuyuki; Machida, Erika; Fukui, Taro; Kakizawa, Nao; Tamaki, Sawako; Ishikawa, Hideki; Rikiyama, Toshiki

doi:10.7759/cureus.14983

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…The TIMI blood flow classification criteria [ 14 ] are as follows: grade 0: coronary artery is completely blocked, no contrast medium passes through; grade 1: contrast medium can penetrate the blocked part but cannot fill the distal coronary artery bed; grade 2: the contrast medium can fill the entire coronary artery, but the blood flow velocity is slower than that of normal vessels and the emptying of the contrast medium is delayed at the distal end of the stenosis. Grade 3: the contrast medium completely filled the whole coronary artery, and the flow rate was consistent with that of normal blood vessels, and the contrast medium emptying was normal [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Liu

Qiu

Yang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Based on a retrospective cohort study, to investigate the value of rivaroxaban combined with ticagrelor in antithrombotic therapy after PCI in patients with nonvalvular atrial fibrillation with acute coronary syndrome. Methods. A total of 60 patients from January 2019 to May 2021 accepted therapy with antithrombotic therapy after PCI. The patients treated with ticagrelor were set as the control group, and those given rivaroxaban combined with ticagrelor were set as the research group. The curative effect, myocardial level, TIMI blood flow grade, platelet aggregation rate, and the incidence of cardiovascular events were taken from the comparisons. Results. The research group’s therapeutic impact was superior to the control group’s therapeutic impact, and the value was higher. After treatment, the myocardial levels of the two groups decreased, and the levels of troponin I, creatine kinase isoenzyme, and hypersensitive C-reactive protein in the research group were greatly less than those in the control group, and the difference was statistically significant ( P < 0.05 ). After operation, the TIMI blood flow classification in the experimental group was better than that in the control group, and the difference was statistically significant ( P < 0.05 ). The experimental group’s platelet aggregation incidence was considerably lower than the control group’s platelet aggregation incidence at 0.5 and 2 hours following surgery, and the difference was statistically significant ( P < 0.05 ). The incidence of acute myocardial infarction, cardiogenic death, and intractable angina pectoris in the research group was significantly lower than that in the control group. Conclusion. Rivaroxaban combined with ticagrelor in the treatment of nonvalvular atrial fibrillation with acute coronary syndrome after percutaneous coronary intervention; the TIMI blood flow grade is better than ticagrelor, which is of great significance to reduce mortality and has high safety in clinical application.

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Section: Methodsmentioning

confidence: 99%

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Liu

Qiu

Yang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…The only other study to specifically address this issue was conducted by Maemoto et al and included 113 patients after hemorrhoidectomy. 15 Of those, 18 patients were on anticoagulation or antiplatelet therapy and 7 (39%) of them experienced PHB. Combined, these data show the increased bleeding risk in patients on anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of oral anticoagulation or antiplatelet inhibitors, scarce data is available. 8,15 Pigot et al investigated the rate of post-operative bleeding in their series of 2513 proctological procedures that included 792 hemorrhoidectomies. 8 Those on uninterrupted oral anticoagulation had a post-operative bleeding rate of 22.7%.…”

Section: Discussionmentioning

confidence: 99%

Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications

Kolbeinsson

Otto

Kogelschatz

et al. 2022

The American Surgeon™

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Background Post-hemorrhoidectomy bleeding is a serious complication after hemorrhoidectomy. In the setting of a new wave of anticoagulants, we aimed to investigate the relationship of post-operative anticoagulation timing and delayed bleeding. Methods We performed a retrospective analysis of all patients undergoing hemorrhoidectomy at a single institution over a 10-year period. Fisher’s exact and Wilcoxon Rank Sum tests were utilized to test for association between delayed bleeding and anticoagulation use. Results Between January 2011 and October 2020, 1469 hemorrhoidectomies were performed. A total of 216 (14.7%) were taking platelet inhibitors and 56 (3.8%) other anticoagulants. Delayed bleeding occurred in 5.2% (n = 76) of which 47% (n = 36) required operative intervention. Mean time to bleeding was 8.7 days (SD ±5.9). Time to bleeding was longer in those taking antiplatelet inhibitors vs. non-platelet inhibitors vs. none (11 vs. 8 vs. 7 days, P = .05). Among anticoagulants (n = 56), novel oral anticoagulants were more common than warfarin (57% vs 43%) and had a nonsignificant increase in delayed bleeding (31% vs 16%, P = .21). Later restart (>3 days) of novel anticoagulants after surgery was associated with increased bleeding (10.5% vs 61.5%, P=.005). On multivariable analysis, only anticoagulation use (OR 4.5, 95% CI: 2.1–10.0), male sex (OR 1.8, 95% CI: 1.1–2.9), and operative oversewing (OR 3.5, 95% CI: 1.8–6.9) were associated with delayed bleeding. Conclusion Post-hemorrhoidectomy bleeding is more likely to occur with patients on anticoagulation. Later restart times within the first week after surgery was not associated with a decrease in bleeding.

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“…The safety of withholding AT during the perioperative period has been well described, but the thoughtful provider must be concerned about the risk of thromboembolic disease while it is held. [1][2][3] There are multiple factors to consider when determining the best perioperative management of AT, including specific patient, drug, and procedure factors.…”

Section: Introductionmentioning

confidence: 99%

“…Occurrence rates are between 0 and 5% following hemorrhoidectomy. [1][2][3][4][5] The risk factors which predispose patients to a PBE have been studied elsewhere, and the effects of sex, number of piles, and lifestyle have been discussed. 3 The use of antithrombotic therapy (AT) is generally considered to increase the risk of PBE after surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Antithrombotic Medications on Postoperative Bleeding Events Following Hemorrhoidectomy

Dean

Pavuluri

Fox

et al. 2022

The American Surgeon™

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Background Bleeding complications are a risk associated with hemorrhoid procedures. Despite the prevalence of anticoagulant and antiplatelet therapies, including newer direct oral anticoagulants (DOACs) in the aging patient population there is a paucity of data regarding the impact of the use of antithrombotic therapy (AT) especially DOACs, on bleeding complications of hemorrhoid procedures. Methods We retrospectively reviewed charts of patients who had undergone a total of 1152 procedures, including hemorrhoid excision and ligation, at a single institution in the years 2016-2018. We noted whether they were prescribed AT, the indication for therapy, perioperative medication management, whether a PBE occurred, and how the PBE was managed. Results PBE’s were noted in 5.92% of patients on ATs, as opposed to 2.66% of patients not on ATs ( P = .014.) The odds ratio of having a PBE when on ATs vs not on ATs is 2.3 (95% CI 1.21 to 4.38, P = .011). Seven out of 40 (17.5%) total PBE’s required hospital admission or repeat procedure, and this was not associated with AT use. Surprisingly, although males represented most of the patients on ATs, females were statistically more likely to have a PBE following a hemorrhoidectomy if on ATs. Discussion Patients on AT have an elevated risk of PBE compared to patients not on AT. No significant difference was found between the two groups when considering only those PBE’s severe enough to require hospital admission or repeat procedure. Further research is required to establish clear guidelines regarding the perioperative management of AT for hemorrhoid procedures.

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Effect of Antithrombotic Therapy on Secondary Bleeding After Proctological Surgery

Cited by 5 publications

References 17 publications

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications

The Impact of Antithrombotic Medications on Postoperative Bleeding Events Following Hemorrhoidectomy

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