VPB1006 - Mini-invasive surgical treatment of haemorrhoiadal bleeding in patients with cardiovascular disease under antithrombotic therapy

Background: A large amount of comorbidity patients have a frequent complication such as gastrointestinal bleeding due to long-term antithrombotic therapy. For instance, haemorrhoids and, consequently, haemorrhoidal bleeding significant decreases the quality of life for patients with cardiovascular disease, who have the high risk of thrombotic or ischemic events. Surgery for these patients requires mini-invasive technic, radical result and minimize to risk of postoperative complications under antiplatelet or anticoagulant therapy.

Aims: The goal of research was to find surgical management of recurrent haemorrhoidal bleeding in cardiovascular patients with no influence to systemic haemostasis.

Methods: We studied 86 patients with cardiovascular disease and hemorrhoids. 45 patients from them had recurrent haemorrhoidal bleeding, causing to chronic anemia, need to constantly antiplatelet (ASA, Clopidogrel) or anticoagulant (VKA, NOACs) therapy and had not positive effect by basic treatment (phlebotonics and topical). In Group 1, contained in 23 patients, were underwent mini-invasive doppler-guided haemorrhoidal artery ligation with recto-anal repair without interrupting antithrombotic therapy in the preoperative period. Group 2 was represented 22 patients in which were used haemorhhoidectomy by Milligan-Morgan with 3-7 days period of rejecting antithrombotic therapy.

Results: Despite to continued antithrombotic therapy in Group 1 was established the lower grade of intraoperative bleeding and postoperative pain compared to Group 2. In Group 1 the bridge-therapy with LMWH was used in 6 patients with warfarin. No bleeding or thrombotic complications were observed postoperatively in this Group. All of these patients have been denying recurrent hemorrhoidal bleeding as well. In the early postoperative period hemorrhagic complications, requiring rectal revision and haemostasis, have been noted in 5 patients of Group 2.

Conclusion(s): Doppler-guided haemorrhoidal artery ligation is the effective and secure method for treatment of haemorrhoids which did not require interrupting antithrombotic therapy and have not affected systemic haemostasis in patients with cardiovascular disease.