Evidence map›Paper›PMID 27170327›Full record

ArticleTechniques in coloproctology2016

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

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

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In one paragraph

Article in Techniques in coloproctology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04188171 (Sclerotherapy With Polidocanol Foam In The Management Of First, Second And Third-Grade Hemorrhoidal Disease In Patients With Bleeding Disorders), which is not on this map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04188171 phase2 / phase3unknown statusnot on this mapstarted 2018, after this paper: background citation

Sclerotherapy With Polidocanol Foam In The Management Of First, Second And Third-Grade Hemorrhoidal Disease In Patients With Bleeding Disorders: A Prospective Cohort Study

TypeinterventionalSponsorUniversidade do PortoRan2018 to 2021Enrolled150ConditionsHemorrhoids, Bleeding DisorderArmsPolidocanol foam sclerotherapy
3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

  1. Article
  2. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

S AtallahFlorida Hospital, Winter Park, FL, USA. atallah@post.harvard.edu.
G K MaharajaFlorida Hospital, Winter Park, FL, USA.
B Martin-PerezFlorida Hospital, Winter Park, FL, USA.
J P BurkeFlorida Hospital, Winter Park, FL, USA.
M R AlbertFlorida Hospital, Winter Park, FL, USA.
S W LarachFlorida Hospital, Winter Park, FL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundApproximately 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.

methodsDuring 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.

resultsDuring 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).

conclusionsThese preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.

Indexed as

AdultAgedAnticoagulantsBlood Loss, SurgicalFemaleHemorrhoidectomyHemorrhoidsHumansMaleMiddle AgedOperative TimePostoperative HemorrhageRecurrenceRetrospective StudiesTransanal Endoscopic SurgeryAnticoagulantsAnticoagulationHemorrhoidsPostoperative hemorrhageTHDTransanal hemorrhoidal dearterialization

Identifiers

PMID27170327
PMCPMC4920854

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Registered trials

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