SURGICAL TREATMENT OF HEMORRHOIDAL BLEEDING IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDER ANTICOAGULANT AND ANTIPLATELET THERAPY

The OBJECTIVE was to build an algorithm for medical and surgical treatment of hemorrhoidal bleedings in patients with cardiovascular diseases under anticoagulant and antiplatelet therapy.

MATERIAL AND METHODS. The research was based on the analysis of results of treatment of hemorrhoidal bleedings in 86 patients with comorbidity (chronic combined hemorrhoids (2–4 stages) and cardiovascular diseases) under antiplatelet and antithrombotic therapy. Doppler-guided hemorrhoid artery ligation (with or without recto-anal repair) was used for the patients from the study group with no interrupting regular antiplatelet and anticoagulant therapy, whereas, in control group of patients, antithrombotic therapy was rejected for three to seven days in order to implementation of hemorrhoidectomy by Milligan – Morgan.

RESULTS. The doppler-guided hemorrhoid artery ligation with recto-anal repair was a minimally invasive method without intra-operative blood loss with lowest pain syndrome at the short in hospital staying in comparison to hemorrhoidectomy by Milligan – Morgan. This fact determined the great clinical and economic effectiveness of the research method for the treatment of hemorrhoidal bleedings in patients with comorbidity.

CONCLUSION. The minimal invasive surgical method of treatment hemorrhoidal bleedings – doppler-guided hemorrhoid artery ligation – could be used for patients with cardiovascular diseases and did not require interrupting anticoagulant and antiplatelet therapy.

The authors declare no conflict of interest.

The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

1. Guttenplan M. The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Curr Gastroenterol Rep. 2017;19:30.

2. Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist’s view. World J. Gastroenterol. 2015;21:9245–9252.

3. Hovuela C., Carvajal F., Juvany M. et al. HAL-RAr (Doppler guided haemorrhoidal artery ligation recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after twoyears follow-up. Int. J. Surg. 2016;28:39–44.

4. Giannini I., Amato A., Basso L. et al. Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial. Tech. Coloproctol. 2015;19:339–345.

5. Trompetto M., Clerico G., Cocorullo G. F. et al. Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech. Coloproctol. 2015;19:567–575.

6. Carvajal Lopez F., Hovuela Alonso C., Juvany Gomez M. et al. Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life. Surg. Innov. 2019;26:328–336.

7. Abusaaada K., He X., Asad-Ur-Rahman F. et al. Predictors of the Need for Therapeutic Intervention in Older Adult Patients With a Nonvaricea l Gastrointestinal Bleed. South Med. J. 2017;110:83–89.

8. Qiu S., Cai X., Sun Z. et al. Heart Rate Recovery and Risk of Cardiovascular Events and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2017;6:5.

9. Burroughs Pena M. S., Rollins A. Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries. Cardiol. Clin. 2017;35:71–86.

10. Cheung K. S., Leung W. K. Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J. Gastroenterol. 2017;23:1954–1963.

11. Sherwood M. W, Nessel C. C., Hellkamp A. S. et al. Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial. J. Am. Coll. Cardiol. 2015;66:2271–2281.

12. Abraham N. S. Management of Antiplatelet Agents and Anticoagulants in Patients with Gastrointestinal Bleeding. Gastrointest. Endosc. Clin. N. Am. 2015;25:449–462.

13. Kido K., Scalese M. J. Management of Oral Anticoagulation Therapy Af ter Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy. Ann. Pharmacother. 2017;51:1000–1007.

14. Chen W. C., Lin K. H., Huang Y. T. et al. The risk of lower gastrointestinal bleeding in low-dose aspirin users. Aliment. Pharmacol. Ther. 2017;45:1542–1550.

15. Milito G., Lisi G., Aronadio E. et al. Ligasure TM hemorrhoidectomy: how we do. Minerva Gastroenterol. Dietol. 2017;63:44–49.

16. Bhatti M. I., Sajid M. S., Baig M. K. Milligan-Morgan (Open) Versus Fer¬guson Haemorrhoidectomy (Closed): A Systematic Review and MetaAnalysis of Published Randomized, Controlled Trials. World J. Surg. 2016;40:1509–1519.

17. Leong D. P., Joseph P. G., McKee M. et al. Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease. Cirs. Res. 2017;121:695–710.

18. Zhou M. X., Sun R., Chen Y. X. A Literature Review of Antithrombotic Therapy for Patients of Venous Thromboembolic Events with Comorbidity of Coronary Heart Disease. Chin. Med. Scien. J. 2018; 33:120–126.

19. Gurvits G. E., Fradkov E. Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients. World J. Gastroenterol. 2017;23:3945– 3953.