EP174 - Incidence and Severity of Bleeding After Hemorrhoid Rubber Band Ligation: Does Antithrombotic Use Matter?

Purpose/Background: Rubber band ligation (RBL) is a widely utilized procedure for the management of grade I-III internal hemorrhoids. Risks of RBL are well described including the possibility of post-procedural bleeding, which may range in severity. With the increasing prevalence of conditions requiring anticoagulation, more RBL candidates are receiving antiplatelet or anticoagulant therapy. Current guidelines recommend holding anticoagulants and antithrombotic agents in the periprocedural banding period, although data behind these recommendations are sparse. The aim of our study was to compare the incidence and severity of post-RBL bleeding in patients on verses off anticoagulants and antithrombotic agents.

Methods/Interventions: We conducted a retrospective chart review of patients who underwent RBL for internal hemorrhoids within a large colorectal surgery practice in 2024. Providers' practices varied their continuation of anticoagulation, allowing for direct comparison between groups. Demographic data, hemorrhoid grade, location of band placement, number of bands placed, use of antiplatelet or anticoagulant therapy, and indication for anticoagulation or antithrombotic agent were recorded. Outcomes assessed included rates of minor and major bleeding, time to bleeding after banding, ED visits, hospital admissions, blood transfusions, and need for reintervention were recorded. Bleeding was classified as minor if it consisted of passage of blood or clots with spontaneous resolution. Patients without any post-RBL follow up of at least 30 days were excluded from analysis.

Results/Outcomes: 384 patients were included. Mean age was 57 years old; 89% of hemorrhoids were grade III, and 92% of patients underwent placement of a single band. Forty-five patients (12%) were on anticoagulant or antithrombotic therapy. 13 patients (3.4%) experienced any post-banding bleeding. Of these, 2 patients (0.5%) had major bleeding requiring ED visit or hospitalization, and 1 patient (0.3%) required blood transfusion. Median time to bleeding was approximately 14 days. Post-banding bleeding did not differ significantly between the anticoagulation and non-anticoagulation groups (2.2 vs 3.5%, p=0.65). Adjusted logistic regression demonstrated no association between anticoagulation/antithrombotic therapy and rates of bleeding (OR 0.32 [0.03-3.21], p=0.34). Other demographic factors did not demonstrate an association with increased rates of post-RBL bleeding.

Conclusion/Discussion: Overall incidence of post-RBL bleeding was low and did not significantly differ by patients' anticoagulation status. These findings suggest that RBL can be safely performed in appropriately selected patients, regardless of ongoing anticoagulant/antiplatelet therapy. Our findings suggest that the mucosal injury and subsequent ulceration associated with RBL is small and well-tolerated, even in the presence of these medications. Limitations of this study include its small sample size, retrospective design, single-institution setting, and potential for underreporting of mild bleeding events.