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Techniques in Coloproctology
Published in: Techniques in Coloproctology 7/2016

Open Access 01-07-2016 | Original Article

Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?

Authors: S. Atallah, G. K. Maharaja, B. Martin-Perez, J. P. Burke, M. R. Albert, S. W. Larach

Published in: Techniques in Coloproctology | Issue 7/2016

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Abstract

Background

Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation.

Methods

During a 53-month period (February 2009–July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery.

Results

During the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455–3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study’s 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049).

Conclusions

These preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.
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Metadata
Title
Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?
Authors
S. Atallah
G. K. Maharaja
B. Martin-Perez
J. P. Burke
M. R. Albert
S. W. Larach
Publication date
01-07-2016
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 7/2016
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-016-1481-z

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