“It has been estimated that approximately 4.4% of the United States population has symptomatic hemorrhoids, contributing to as many as 2.5 million ambulatory visits annually. Excisional hemorrhoidectomy is the preferred treatment for grade 3-4 hemorrhoids and patients unresponsive to non-operative treatment. Despite being a relatively quick, outpatient procedure, one potential serious complication includes post-hemorrhoidectomy bleeding. Reported rates of this complication have varied. Studies suggest that .4-10% of hemorrhoidectomy cases will be complicated by bleeding and many requiring a second intervention. Among risk factors that have been associated with delayed bleeding are male sex, post-operative constipation, and the use of laxatives. Scarce data exist on the association of baseline oral anticoagulation or antiplatelet medications with delayed bleeding.”

“Post-hemorrhoidectomy bleeding is more common in patients on oral anticoagulation (25%) and platelet inhibitors (9.3%) compared 4.4% when not taking such medications. These results provide a comprehensive assessment of the risk anticoagulation and platelet inhibition medications pose in terms of bleeding in patients undergoing hemorrhoidectomy. The observed median medication restart time and post-operative bleeding time after surgery would suggest that holding medications through the first week after surgery may have the potential to decrease bleeding rate but must be weighted with the risk of thrombotic events. In the future, prospective studies that vary the times of restarting anticoagulation will be needed in order to formulate more concrete guidelines regarding perioperative anticoagulation and hemorrhoidectomy.”

Kolbeinsson, Hordur M et al. “Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications.” The American surgeon vol. 89,11 (2023): 4681-4688.